Hospital

Pike County Memorial Hospital

Pike County Memorial Hospital in Lousiana, MO publishes cash prices for 289 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are below the Missouri median for 211 of 282 procedures and above it for 66. By typical cash price it ranks #15 of 60 Missouri hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

2305 Georgia Street Lousiana MO 63353 Collected Sep 27, 2026 Source price file (573) 754-5531

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 261333 · CMS hospital register

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 US Segmental Pressures LE 1-2 Lvls Bilat	$340.00	$425.00	$340.00–$425.00	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 US Segmental Pressures LE 1-2 Lvls Bilat	$340.00	$425.00	$340.00–$425.00	—	20%
Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone Imaging Whole Body	$722.40	$903.00	$722.40–$903.00	52% below	20%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone Imaging Whole Body	$722.40	$903.00	$722.40–$903.00	—	20%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete Right	$140.00	$175.00	$140.00–$175.00	63% below	20%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete Left.	$140.00	$175.00	$140.00–$175.00	63% below	20%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete Left	$140.00	$175.00	$140.00–$175.00	63% below	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete Left.	$140.00	$175.00	$140.00–$175.00	—	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete Left	$140.00	$175.00	$140.00–$175.00	—	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete Right	$140.00	$175.00	$140.00–$175.00	—	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Right	$108.00	$135.00	$108.00–$135.00	63% below	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Left	$108.00	$135.00	$108.00–$135.00	63% below	20%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Left	$108.00	$135.00	$108.00–$135.00	—	20%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Right	$108.00	$135.00	$108.00–$135.00	—	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US Carotid Duplex Bilateral	$395.20	$494.00	$395.20–$494.00	—	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US Carotid Duplex Bilateral	$395.20	$494.00	$395.20–$494.00	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys both sides CPT 76770 US Renal Bilateral	$556.00	$695.00	$556.00–$695.00	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Complete	$556.00	$695.00	$556.00–$695.00	2% below	20%
Complete ultrasound of the back of the abdomen, such as both kidneys one side CPT 76770 US Renal Right	$556.00	$695.00	$556.00–$695.00	2% below	20%
Complete ultrasound of the back of the abdomen, such as both kidneys one side CPT 76770 US Renal Left	$556.00	$695.00	$556.00–$695.00	2% below	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient both sides CPT 76770 US Renal Bilateral	$556.00	$695.00	$556.00–$695.00	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal Complete	$556.00	$695.00	$556.00–$695.00	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient one side CPT 76770 US Renal Left	$556.00	$695.00	$556.00–$695.00	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient one side CPT 76770 US Renal Right	$556.00	$695.00	$556.00–$695.00	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MG Mammo Digital Diagnostic Bilat.	$268.00	$335.00	$268.00–$335.00	—	20%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG Mammo Digital Diagnostic Bilat.	$268.00	$335.00	$268.00–$335.00	—	20%
Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Digital Diagnostic Left.	$200.00	$250.00	$200.00–$250.00	14% below	20%
Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Digital Diagnostic Right.	$200.00	$250.00	$200.00–$250.00	14% below	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Digital Diagnostic Left.	$200.00	$250.00	$200.00–$250.00	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Digital Diagnostic Right.	$200.00	$250.00	$200.00–$250.00	—	20%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US Lower Ext Arterial Duplex Bilateral	$247.20	$309.00	$247.20–$309.00	—	20%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US Lower Ext Arterial Duplex Bilateral	$247.20	$309.00	$247.20–$309.00	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Lower Ext Venous Duplex Bilateral	$326.40	$408.00	$326.40–$408.00	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Lower Ext Venous Reflux Bilateral	$571.20	$714.00	$571.20–$714.00	—	20%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Lower Ext Venous Duplex Bilateral	$326.40	$408.00	$326.40–$408.00	—	20%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Lower Ext Venous Reflux Bilateral	$571.20	$714.00	$571.20–$714.00	—	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US Echo Bubble Study	$1,469.60	$1,837.00	$1,469.60–$1,837.00	3% below	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US Echo 2D Comp w/ Color Flow Doppler	$1,469.60	$1,837.00	$1,469.60–$1,837.00	3% below	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US Echo 2D Complete w/ Contrast EO	$1,920.00	$2,400.00	$1,920.00–$2,400.00	27% above	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US Echo 2D Comp w/ Color Flow Doppler	$1,469.60	$1,837.00	$1,469.60–$1,837.00	—	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US Echo Bubble Study	$1,469.60	$1,837.00	$1,469.60–$1,837.00	—	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US Echo 2D Complete w/ Contrast EO	$1,920.00	$2,400.00	$1,920.00–$2,400.00	—	20%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 RT Home Sleep Study, Unattended CHARGE	$741.60	$927.00	$741.60–$927.00	12% above	20%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Home Sleep Study	$741.60	$927.00	$741.60–$927.00	12% above	20%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 RT Home Sleep Study, Unattended CHARGE	$741.60	$927.00	$741.60–$927.00	—	20%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 Home Sleep Study	$741.60	$927.00	$741.60–$927.00	—	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysomnography w/ CPAP Trial	$2,099.20	$2,624.00	$2,099.20–$2,624.00	20% below	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysomnography w/ CPAP	$2,099.20	$2,624.00	$2,099.20–$2,624.00	20% below	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Polysomnography w/ CPAP Trial	$2,099.20	$2,624.00	$2,099.20–$2,624.00	—	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Polysomnography w/ CPAP	$2,099.20	$2,624.00	$2,099.20–$2,624.00	—	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocardial SPECT Rest and Stress	$2,848.00	$3,560.00	$2,848.00–$3,560.00	30% below	20%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocardial SPECT Rest and Stress	$2,848.00	$3,560.00	$2,848.00–$3,560.00	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvic Ltd	$160.00	$200.00	$160.00–$200.00	60% below	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvic Non OB Ltd	$288.00	$360.00	$288.00–$360.00	29% below	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvic Ltd	$160.00	$200.00	$160.00–$200.00	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvic Non OB Ltd	$288.00	$360.00	$288.00–$360.00	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvic Non OB	$518.40	$648.00	$518.40–$648.00	20% below	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvic Non OB	$518.40	$648.00	$518.40–$648.00	—	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB Greater Than 14 Weeks	$531.20	$664.00	$531.20–$664.00	7% below	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB Greater Than 14 Weeks	$531.20	$664.00	$531.20–$664.00	—	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB Less Than 14 Weeks Single	$531.20	$664.00	$531.20–$664.00	4% above	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB Less Than 14 Weeks Single	$531.20	$664.00	$531.20–$664.00	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB Limited	$482.40	$603.00	$482.40–$603.00	34% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB Limited	$482.40	$603.00	$482.40–$603.00	—	20%
Screening mammogram, both breasts both sides CPT 77067 MG Mammo Digital Screening Bilateral.	$228.00	$285.00	$228.00–$285.00	—	20%
Screening mammogram, both breasts both sides CPT 77067 MG Mammo Digital Screening Bilateral	$228.00	$285.00	$228.00–$285.00	—	20%
Screening mammogram, both breasts one side CPT 77067 MG Mammo Digital Screening Right.	$228.00	$285.00	$228.00–$285.00	38% above	20%
Screening mammogram, both breasts one side CPT 77067 MG Mammo Digital Screening Left.	$228.00	$285.00	$228.00–$285.00	38% above	20%
Screening mammogram, both breasts inpatient both sides CPT 77067 MG Mammo Digital Screening Bilateral.	$228.00	$285.00	$228.00–$285.00	—	20%
Screening mammogram, both breasts inpatient both sides CPT 77067 MG Mammo Digital Screening Bilateral	$228.00	$285.00	$228.00–$285.00	—	20%
Screening mammogram, both breasts inpatient one side CPT 77067 MG Mammo Digital Screening Right.	$228.00	$285.00	$228.00–$285.00	—	20%
Screening mammogram, both breasts inpatient one side CPT 77067 MG Mammo Digital Screening Left.	$228.00	$285.00	$228.00–$285.00	—	20%
Sleep study in a lab (polysomnography) CPT 95810 RT Polysomnography CHARGE	$1,836.00	$2,295.00	$1,836.00–$2,295.00	27% below	20%
Sleep study in a lab (polysomnography) CPT 95810 Polysomnography	$1,836.00	$2,295.00	$1,836.00–$2,295.00	27% below	20%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysomnography	$1,836.00	$2,295.00	$1,836.00–$2,295.00	—	20%
Sleep study in a lab (polysomnography) inpatient CPT 95810 RT Polysomnography CHARGE	$1,836.00	$2,295.00	$1,836.00–$2,295.00	—	20%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 US Stress Echo	$1,120.00	$1,400.00	$1,120.00–$1,400.00	36% below	20%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 US Stress Echo	$1,120.00	$1,400.00	$1,120.00–$1,400.00	—	20%
Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non-OB	$478.40	$598.00	$478.40–$598.00	18% below	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non-OB	$478.40	$598.00	$478.40–$598.00	—	20%
Transvaginal ultrasound during pregnancy CPT 76817 US OB Transvaginal	$482.40	$603.00	$482.40–$603.00	3% above	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB Transvaginal	$482.40	$603.00	$482.40–$603.00	—	20%
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete	$556.00	$695.00	$556.00–$695.00	29% below	20%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete	$556.00	$695.00	$556.00–$695.00	—	20%
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum (Contents)	$484.80	$606.00	$484.80–$606.00	16% below	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum (Contents)	$484.80	$606.00	$484.80–$606.00	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Head/Neck Soft Tissue	$448.00	$560.00	$448.00–$560.00	21% below	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Thyroid	$448.00	$560.00	$448.00–$560.00	21% below	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Thyroid	$448.00	$560.00	$448.00–$560.00	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Head/Neck Soft Tissue	$448.00	$560.00	$448.00–$560.00	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Lower Ext Venous Duplex Left	$244.80	$306.00	$244.80–$306.00	56% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Upper Ext Venous Duplex Right	$244.80	$306.00	$244.80–$306.00	56% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Upper Ext Venous Duplex Left	$244.80	$306.00	$244.80–$306.00	56% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Lower Ext Venous Duplex Right	$244.80	$306.00	$244.80–$306.00	56% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Lower Ext Venous Duplex Right	$244.80	$306.00	$244.80–$306.00	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Lower Ext Venous Duplex Left	$244.80	$306.00	$244.80–$306.00	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Upper Ext Venous Duplex Right	$244.80	$306.00	$244.80–$306.00	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Upper Ext Venous Duplex Left	$244.80	$306.00	$244.80–$306.00	—	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT QST	$27.20	$34.00	$27.20–$34.00	44% below	20%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine Aminotransferase	$27.20	$34.00	$27.20–$34.00	44% below	20%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Alanine Aminotransferase	$27.20	$34.00	$27.20–$34.00	—	20%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT QST	$27.20	$34.00	$27.20–$34.00	—	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 Aspartate Aminotransferase	$27.20	$34.00	$27.20–$34.00	42% below	20%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Aspartate Aminotransferase	$27.20	$34.00	$27.20–$34.00	—	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute Hepatitis Panel w/Rfx to Confirm. QST	$276.00	$345.00	$276.00–$345.00	17% above	20%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Acute Hepatitis Panel w/Rfx to Confirm. QST	$276.00	$345.00	$276.00–$345.00	—	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Cow's Milk (F2) IgE QST	$8.80	$11.00	$8.80–$11.00	60% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Scallop (F338) IgE QST	$8.80	$11.00	$8.80–$11.00	60% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Soybean (F14) IgE QST	$8.80	$11.00	$8.80–$11.00	60% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Hazelnut (F17) IgE QST	$8.80	$11.00	$8.80–$11.00	60% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Almond (F20) IgE QST	$8.80	$11.00	$8.80–$11.00	60% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Egg White (F1) IgE QST	$8.80	$11.00	$8.80–$11.00	60% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Sesame Seed (F10) IgE QST	$8.80	$11.00	$8.80–$11.00	60% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Cashew Nut (F202) IgE QST	$8.80	$11.00	$8.80–$11.00	60% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Peanut (F13) IgE QST	$8.80	$11.00	$8.80–$11.00	60% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Walnut (F256) IgE QST	$8.80	$11.00	$8.80–$11.00	60% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Wheat (F4) IgE QST	$8.80	$11.00	$8.80–$11.00	60% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Cherry (f242) IgE QST	$16.80	$21.00	$16.80–$21.00	24% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Dermatophagoides Farinae (D2) IgE QST	$21.60	$27.00	$21.60–$27.00	2% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Dog Dander (E5) IgE QST	$21.60	$27.00	$21.60–$27.00	2% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Mountain Cedar (T6) IgE QST	$21.60	$27.00	$21.60–$27.00	2% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Maple (Box Elder) (T1) IgE QST	$21.60	$27.00	$21.60–$27.00	2% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Elm (T8) IgE QST	$21.60	$27.00	$21.60–$27.00	2% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Timothy Grass (G6) IgE QST	$21.60	$27.00	$21.60–$27.00	2% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Hickory/Pecan Tree (T22) IgE QST	$21.60	$27.00	$21.60–$27.00	2% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillus fumigatus (M3) IgE QST	$21.60	$27.00	$21.60–$27.00	2% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Bermuda Grass (G2) IgE QST	$21.60	$27.00	$21.60–$27.00	2% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Cat Dander (E1) IgE QST	$21.60	$27.00	$21.60–$27.00	2% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Russian Thistle (W11) IgE QST	$21.60	$27.00	$21.60–$27.00	2% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Cockroach (I6) IgE QST	$21.60	$27.00	$21.60–$27.00	2% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Rough Pigweed (W14) IgE QST	$21.60	$27.00	$21.60–$27.00	2% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Common Ragweed (Short) (W1) IgE QST	$21.60	$27.00	$21.60–$27.00	2% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Rough Marsh Elder (W16) IgE QST	$21.60	$27.00	$21.60–$27.00	2% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Penicillium Notatum (M1) IgE QST	$21.60	$27.00	$21.60–$27.00	2% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Sycamore (T11) IgE QST	$21.60	$27.00	$21.60–$27.00	2% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 D. Pteronyssinus (D1) IgE QST	$21.60	$27.00	$21.60–$27.00	2% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Mouse Urine Proteins (E72) IgE QST	$21.60	$27.00	$21.60–$27.00	2% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 White Ash (T15) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Alternaria alternata (M6) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillus Fum Class QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillus Fumigatus (M3) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Beef (Bos Spp) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Brome Grass (G11) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Candida albicans (M5) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Cladosporium herbarum (M2) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Codfish (F3) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Cottonwood (T14) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Crab (F23) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Firebush (W17) Ige QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Galactose Alpha 1,3 Galactose IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Johnson Grass (G10) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 June Grass(Kentucky Blue) (G8) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Lamb/Mutton (Ovis Spp)IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Lamb's Quarters (W10) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Lobster (F80) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Meadow Fescue (G4) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Mucor racemosus (M4) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Mugwort (w6) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Oak (T7) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Olive tree (t9) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Orchard Grass (Cocksfoot) (G3) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Pork (Sus Spp) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Russian Thistle Class QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Salmon (F41) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Scale (W15) Ige QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Walnut Tree (T10) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Tuna (F40) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Shrimp (F24) IgE QST	$29.60	$37.00	$29.60–$37.00	34% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Buckwheat (f11) IgE QST	$76.00	$95.00	$76.00–$95.00	244% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Rice (F9) IgE QST	$76.00	$95.00	$76.00–$95.00	244% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Barley (f6) IgE QST	$76.00	$95.00	$76.00–$95.00	244% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Gluten (F79) IgE QST	$76.00	$95.00	$76.00–$95.00	244% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Rye (F5) IgE QST	$76.00	$95.00	$76.00–$95.00	244% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Histone Abs QST	$140.00	$175.00	$140.00–$175.00	533% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Food and Tree Nut Allergy Panel with Reflex to Components QST	$247.20	$309.00	$247.20–$309.00	1019% above	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Wheat (F4) IgE QST	$8.80	$11.00	$8.80–$11.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Egg White (F1) IgE QST	$8.80	$11.00	$8.80–$11.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cow's Milk (F2) IgE QST	$8.80	$11.00	$8.80–$11.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Soybean (F14) IgE QST	$8.80	$11.00	$8.80–$11.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Walnut (F256) IgE QST	$8.80	$11.00	$8.80–$11.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hazelnut (F17) IgE QST	$8.80	$11.00	$8.80–$11.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Almond (F20) IgE QST	$8.80	$11.00	$8.80–$11.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sesame Seed (F10) IgE QST	$8.80	$11.00	$8.80–$11.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cashew Nut (F202) IgE QST	$8.80	$11.00	$8.80–$11.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Scallop (F338) IgE QST	$8.80	$11.00	$8.80–$11.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Peanut (F13) IgE QST	$8.80	$11.00	$8.80–$11.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cherry (f242) IgE QST	$16.80	$21.00	$16.80–$21.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mouse Urine Proteins (E72) IgE QST	$21.60	$27.00	$21.60–$27.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Aspergillus fumigatus (M3) IgE QST	$21.60	$27.00	$21.60–$27.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 D. Pteronyssinus (D1) IgE QST	$21.60	$27.00	$21.60–$27.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Penicillium Notatum (M1) IgE QST	$21.60	$27.00	$21.60–$27.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Common Ragweed (Short) (W1) IgE QST	$21.60	$27.00	$21.60–$27.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rough Marsh Elder (W16) IgE QST	$21.60	$27.00	$21.60–$27.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cockroach (I6) IgE QST	$21.60	$27.00	$21.60–$27.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rough Pigweed (W14) IgE QST	$21.60	$27.00	$21.60–$27.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Russian Thistle (W11) IgE QST	$21.60	$27.00	$21.60–$27.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Timothy Grass (G6) IgE QST	$21.60	$27.00	$21.60–$27.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hickory/Pecan Tree (T22) IgE QST	$21.60	$27.00	$21.60–$27.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cat Dander (E1) IgE QST	$21.60	$27.00	$21.60–$27.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Elm (T8) IgE QST	$21.60	$27.00	$21.60–$27.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sycamore (T11) IgE QST	$21.60	$27.00	$21.60–$27.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Maple (Box Elder) (T1) IgE QST	$21.60	$27.00	$21.60–$27.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dog Dander (E5) IgE QST	$21.60	$27.00	$21.60–$27.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mountain Cedar (T6) IgE QST	$21.60	$27.00	$21.60–$27.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dermatophagoides Farinae (D2) IgE QST	$21.60	$27.00	$21.60–$27.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bermuda Grass (G2) IgE QST	$21.60	$27.00	$21.60–$27.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lamb/Mutton (Ovis Spp)IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White Ash (T15) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Walnut Tree (T10) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Tuna (F40) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Shrimp (F24) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Scale (W15) Ige QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Salmon (F41) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Russian Thistle Class QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pork (Sus Spp) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Orchard Grass (Cocksfoot) (G3) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Olive tree (t9) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Oak (T7) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mugwort (w6) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mucor racemosus (M4) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Meadow Fescue (G4) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lobster (F80) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lamb's Quarters (W10) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 June Grass(Kentucky Blue) (G8) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Johnson Grass (G10) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Galactose Alpha 1,3 Galactose IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Firebush (W17) Ige QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Crab (F23) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cottonwood (T14) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Codfish (F3) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cladosporium herbarum (M2) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Candida albicans (M5) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Brome Grass (G11) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Beef (Bos Spp) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Aspergillus Fumigatus (M3) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Aspergillus Fum Class QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Alternaria alternata (M6) IgE QST	$29.60	$37.00	$29.60–$37.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Barley (f6) IgE QST	$76.00	$95.00	$76.00–$95.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Gluten (F79) IgE QST	$76.00	$95.00	$76.00–$95.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rice (F9) IgE QST	$76.00	$95.00	$76.00–$95.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rye (F5) IgE QST	$76.00	$95.00	$76.00–$95.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Buckwheat (f11) IgE QST	$76.00	$95.00	$76.00–$95.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Histone Abs QST	$140.00	$175.00	$140.00–$175.00	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Food and Tree Nut Allergy Panel with Reflex to Components QST	$247.20	$309.00	$247.20–$309.00	—	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP Ab (IgG) QST	$82.40	$103.00	$82.40–$103.00	3% above	20%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP Ab (IgG) QST	$82.40	$103.00	$82.40–$103.00	—	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA Screen, IFA QST	$56.00	$70.00	$56.00–$70.00	18% below	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA Screen, IFA, w/Refl Tit &Pattern QST	$56.00	$70.00	$56.00–$70.00	18% below	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA Screen, IFA QST	$56.00	$70.00	$56.00–$70.00	—	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA Screen, IFA, w/Refl Tit &Pattern QST	$56.00	$70.00	$56.00–$70.00	—	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-Type Natriuretic Peptide	$142.40	$178.00	$142.40–$178.00	16% above	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT Pro BNP QST	$142.40	$178.00	$142.40–$178.00	16% above	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT-ProBNP II	$200.00	$250.00	$200.00–$250.00	63% above	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT Pro BNP QST	$142.40	$178.00	$142.40–$178.00	—	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-Type Natriuretic Peptide	$142.40	$178.00	$142.40–$178.00	—	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT-ProBNP II	$200.00	$250.00	$200.00–$250.00	—	20%
Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel	$126.40	$158.00	$126.40–$158.00	2% above	20%
Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel	$126.40	$158.00	$126.40–$158.00	—	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Bill Only AP 88305 Surg Level IV	$212.80	$266.00	$212.80–$266.00	4% above	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Bill Only AP 88305 Surg Level IV	$212.80	$266.00	$212.80–$266.00	—	20%
Blood culture for bacteria CPT 87040 Blood Culture #2 PIKE	$59.20	$74.00	$59.20–$74.00	47% below	20%
Blood culture for bacteria CPT 87040 Blood Culture #1 PIKE	$59.20	$74.00	$59.20–$74.00	47% below	20%
Blood culture for bacteria inpatient CPT 87040 Blood Culture #2 PIKE	$59.20	$74.00	$59.20–$74.00	—	20%
Blood culture for bacteria inpatient CPT 87040 Blood Culture #1 PIKE	$59.20	$74.00	$59.20–$74.00	—	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Bill Only Venipuncture	$12.80	$16.00	$12.80–$16.00	24% below	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 36415 Collection of venous blood by venipuncture	$12.80	$16.00	$12.80–$16.00	24% below	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw	$12.80	$16.00	$12.80–$16.00	24% below	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Bill Only Venipuncture Special/Complex	$33.60	$42.00	$33.60–$42.00	100% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Bill Only Quest venipuncture and handling charge	$33.60	$42.00	$33.60–$42.00	100% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Bill Only Quest Collection	$33.60	$42.00	$33.60–$42.00	100% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 BIll Only Boston Heart Send Out	$33.60	$42.00	$33.60–$42.00	100% above	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Bill Only Venipuncture	$12.80	$16.00	$12.80–$16.00	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 36415 Collection of venous blood by venipuncture	$12.80	$16.00	$12.80–$16.00	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw	$12.80	$16.00	$12.80–$16.00	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Bill Only Venipuncture Special/Complex	$33.60	$42.00	$33.60–$42.00	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Bill Only Quest venipuncture and handling charge	$33.60	$42.00	$33.60–$42.00	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Bill Only Quest Collection	$33.60	$42.00	$33.60–$42.00	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BIll Only Boston Heart Send Out	$33.60	$42.00	$33.60–$42.00	—	20%
Blood glucose (sugar) test CPT 82947 Glucose 2 Hour Post Prandial	$27.20	$34.00	$27.20–$34.00	17% below	20%
Blood glucose (sugar) test inpatient CPT 82947 Glucose 2 Hour Post Prandial	$27.20	$34.00	$27.20–$34.00	—	20%
Blood lead test CPT 83655 Lead (Venous), OSHA and Zinc Protoporphyrin Evaluation QST	$48.00	$60.00	$48.00–$60.00	12% below	20%
Blood lead test CPT 83655 Lead QST	$52.80	$66.00	$52.80–$66.00	3% below	20%
Blood lead test inpatient CPT 83655 Lead (Venous), OSHA and Zinc Protoporphyrin Evaluation QST	$48.00	$60.00	$48.00–$60.00	—	20%
Blood lead test inpatient CPT 83655 Lead QST	$52.80	$66.00	$52.80–$66.00	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Pregnancy Test Serum Qual	$42.40	$53.00	$42.40–$53.00	20% below	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Pregnancy Test Serum Qual	$42.40	$53.00	$42.40–$53.00	—	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Bill Only ABO	$18.40	$23.00	$18.40–$23.00	75% below	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 REF ABO	$36.00	$45.00	$36.00–$45.00	50% below	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 REF ABO/Rh	$36.00	$45.00	$36.00–$45.00	50% below	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/Rh	$36.00	$45.00	$36.00–$45.00	50% below	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Bill Only ABO/Rh	$36.00	$45.00	$36.00–$45.00	50% below	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Bill Only ABO	$18.40	$23.00	$18.40–$23.00	—	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 REF ABO	$36.00	$45.00	$36.00–$45.00	—	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO/Rh	$36.00	$45.00	$36.00–$45.00	—	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 REF ABO/Rh	$36.00	$45.00	$36.00–$45.00	—	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Bill Only ABO/Rh	$36.00	$45.00	$36.00–$45.00	—	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein	$44.00	$55.00	$44.00–$55.00	26% below	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein QST	$44.00	$55.00	$44.00–$55.00	26% below	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein High Sensitivity	$64.00	$80.00	$64.00–$80.00	8% above	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein QST	$44.00	$55.00	$44.00–$55.00	—	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein	$44.00	$55.00	$44.00–$55.00	—	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein High Sensitivity	$64.00	$80.00	$64.00–$80.00	—	20%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 QST	$114.40	$143.00	$114.40–$143.00	4% above	20%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 QST	$114.40	$143.00	$114.40–$143.00	—	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 QST	$114.40	$143.00	$114.40–$143.00	5% above	20%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125 QST	$114.40	$143.00	$114.40–$143.00	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 RNA (COVID-19), Qualitative NAAT QST	$300.00	$375.00	$300.00–$375.00	200% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 RNA (COVID-19), Qualitative NAAT QST	$300.00	$375.00	$300.00–$375.00	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachomatis RNA, TMA QST	$80.00	$100.00	$80.00–$100.00	11% below	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia Trachomatis RNA, TMA QST	$80.00	$100.00	$80.00–$100.00	—	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel	$76.00	$95.00	$76.00–$95.00	26% below	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel	$76.00	$95.00	$76.00–$95.00	—	20%
Complete blood count (CBC) with differential CPT 85025 CBC w/ Differential	$56.80	$71.00	$56.80–$71.00	7% above	20%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ Differential	$56.80	$71.00	$56.80–$71.00	—	20%
Complete blood count (CBC), no differential CPT 85027 CBC without Differential	$27.20	$34.00	$27.20–$34.00	45% below	20%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC without Differential	$27.20	$34.00	$27.20–$34.00	—	20%
Comprehensive metabolic panel (blood test) CPT 80053 CMP	$148.80	$186.00	$148.80–$186.00	18% above	20%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMP	$148.80	$186.00	$148.80–$186.00	—	20%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer	$160.00	$200.00	$160.00–$200.00	28% above	20%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer	$160.00	$200.00	$160.00–$200.00	—	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA Sulfate QST	$127.20	$159.00	$127.20–$159.00	7% below	20%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA Sulfate QST	$127.20	$159.00	$127.20–$159.00	—	20%
Estradiol blood test CPT 82670 Estradiol, Ultrasensitive LC/MS/MS QST	$135.20	$169.00	$135.20–$169.00	6% below	20%
Estradiol blood test CPT 82670 Estradiol QST	$135.20	$169.00	$135.20–$169.00	6% below	20%
Estradiol blood test inpatient CPT 82670 Estradiol, Ultrasensitive LC/MS/MS QST	$135.20	$169.00	$135.20–$169.00	—	20%
Estradiol blood test inpatient CPT 82670 Estradiol QST	$135.20	$169.00	$135.20–$169.00	—	20%
FSH (follicle-stimulating hormone) test CPT 83001 FSH, Ped QST	$81.60	$102.00	$81.60–$102.00	20% below	20%
FSH (follicle-stimulating hormone) test CPT 83001 FSH QST	$81.60	$102.00	$81.60–$102.00	20% below	20%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH, Ped QST	$81.60	$102.00	$81.60–$102.00	—	20%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH QST	$81.60	$102.00	$81.60–$102.00	—	20%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Stool QST	$329.60	$412.00	$329.60–$412.00	77% above	20%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin, Stool QST	$329.60	$412.00	$329.60–$412.00	—	20%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$56.80	$71.00	$56.80–$71.00	32% below	20%
Ferritin blood test (iron stores) CPT 82728 Ferritin QST	$56.80	$71.00	$56.80–$71.00	32% below	20%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin QST	$56.80	$71.00	$56.80–$71.00	—	20%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin	$56.80	$71.00	$56.80–$71.00	—	20%
Folate (folic acid) blood test CPT 82746 Folate Level	$64.00	$80.00	$64.00–$80.00	16% below	20%
Folate (folic acid) blood test CPT 82746 Folate QST	$64.00	$80.00	$64.00–$80.00	16% below	20%
Folate (folic acid) blood test inpatient CPT 82746 Folate QST	$64.00	$80.00	$64.00–$80.00	—	20%
Folate (folic acid) blood test inpatient CPT 82746 Folate Level	$64.00	$80.00	$64.00–$80.00	—	20%
Free T3 thyroid hormone test CPT 84481 T3, Free QST	$131.20	$164.00	$131.20–$164.00	32% above	20%
Free T3 thyroid hormone test inpatient CPT 84481 T3, Free QST	$131.20	$164.00	$131.20–$164.00	—	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4 Level	$66.40	$83.00	$66.40–$83.00	10% below	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Free T4 Level	$66.40	$83.00	$66.40–$83.00	—	20%
Free testosterone test CPT 84402 Testosterone, Free QST	$81.60	$102.00	$81.60–$102.00	35% below	20%
Free testosterone test inpatient CPT 84402 Testosterone, Free QST	$81.60	$102.00	$81.60–$102.00	—	20%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General Health Panel	$280.00	$350.00	$280.00–$350.00	1% above	20%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 General Health Panel	$280.00	$350.00	$280.00–$350.00	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Gestational Diabetes Screen	$27.20	$34.00	$27.20–$34.00	36% below	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Gestational Diabetes Screen	$27.20	$34.00	$27.20–$34.00	—	20%
Glucose tolerance test, 3 samples CPT 82951 .GTT 1 HR OB 100gm	$75.20	$94.00	$75.20–$94.00	17% below	20%
Glucose tolerance test, 3 samples CPT 82951 .GTT 1 HR	$75.20	$94.00	$75.20–$94.00	17% below	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 .GTT 1 HR OB 100gm	$75.20	$94.00	$75.20–$94.00	—	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 .GTT 1 HR	$75.20	$94.00	$75.20–$94.00	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrhoeae RNA, TMA QST	$80.00	$100.00	$80.00–$100.00	2% below	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria Gonorrhoeae RNA, TMA QST	$80.00	$100.00	$80.00–$100.00	—	20%
H. pylori stool antigen test CPT 87338 H. Pylori Ag, EIA, Stool QST	$99.20	$124.00	$99.20–$124.00	17% below	20%
H. pylori stool antigen test inpatient CPT 87338 H. Pylori Ag, EIA, Stool QST	$99.20	$124.00	$99.20–$124.00	—	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 RNA, Quant Real Time PCR QST	$212.00	$265.00	$212.00–$265.00	39% below	20%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 RNA, Quant Real Time PCR QST	$212.00	$265.00	$212.00–$265.00	—	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV Ag/Ab Combo 1/2 Screen	$68.00	$85.00	$68.00–$85.00	16% below	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1/2 Ag/Ab, Fourth Gen w/Rfl QST	$68.00	$85.00	$68.00–$85.00	16% below	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1/2 Ag/Ab, Fourth Gen w/Rfl QST	$68.00	$85.00	$68.00–$85.00	—	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV Ag/Ab Combo 1/2 Screen	$68.00	$85.00	$68.00–$85.00	—	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV RNA HR E6/E7 TMA QST	$96.00	$120.00	$96.00–$120.00	13% below	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 THINPREP TIS AND HPV mRNA E6/E7 QST	$271.20	$339.00	$271.20–$339.00	145% above	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV RNA HR E6/E7 TMA QST	$96.00	$120.00	$96.00–$120.00	—	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 THINPREP TIS AND HPV mRNA E6/E7 QST	$271.20	$339.00	$271.20–$339.00	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c QST	$66.40	$83.00	$66.40–$83.00	8% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hgb A1c	$66.40	$83.00	$66.40–$83.00	8% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hgb A1c	$66.40	$83.00	$66.40–$83.00	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c QST	$66.40	$83.00	$66.40–$83.00	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hep B Surface Ab Ql QST	$64.80	$81.00	$64.80–$81.00	6% below	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hep B Surface Antibody Ql QST	$64.80	$81.00	$64.80–$81.00	6% below	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hep B Surface Ab Ql QST	$64.80	$81.00	$64.80–$81.00	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hep B Surface Antibody Ql QST	$64.80	$81.00	$64.80–$81.00	—	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hep B Surface Ag w/Refl Confirm QST	$52.80	$66.00	$52.80–$66.00	18% below	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hep B Surface Ag QST	$52.80	$66.00	$52.80–$66.00	18% below	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hep B Surface Ag QST	$52.80	$66.00	$52.80–$66.00	—	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hep B Surface Ag w/Refl Confirm QST	$52.80	$66.00	$52.80–$66.00	—	20%
Hepatitis C antibody blood test (screening) CPT 86803 HCV RNA, Qn PCR w/Rflx To Geno, LIPA QST	$72.80	$91.00	$72.80–$91.00	14% below	20%
Hepatitis C antibody blood test (screening) CPT 86803 Hep C Ab QST	$72.80	$91.00	$72.80–$91.00	14% below	20%
Hepatitis C antibody blood test (screening) CPT 86803 Hep C Ab w/Refl To HCV RNA, Qn, PCR QST	$72.80	$91.00	$72.80–$91.00	14% below	20%
Hepatitis C antibody blood test (screening) CPT 86803 HCV Ab Rfx RNA, PCR Rfx Geno,LiPA QST	$72.80	$91.00	$72.80–$91.00	14% below	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hep C Ab QST	$72.80	$91.00	$72.80–$91.00	—	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hep C Ab w/Refl To HCV RNA, Qn, PCR QST	$72.80	$91.00	$72.80–$91.00	—	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HCV Ab Rfx RNA, PCR Rfx Geno,LiPA QST	$72.80	$91.00	$72.80–$91.00	—	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HCV RNA, Qn PCR w/Rflx To Geno, LIPA QST	$72.80	$91.00	$72.80–$91.00	—	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 HCV RNA, Qn PCR w/Rfx to Gt, LiPA(R) QST	$247.20	$309.00	$247.20–$309.00	17% below	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 HCV RNA, Quantitative Real Time PCR QST	$247.20	$309.00	$247.20–$309.00	17% below	20%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCV RNA, Qn PCR w/Rfx to Gt, LiPA(R) QST	$247.20	$309.00	$247.20–$309.00	—	20%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCV RNA, Quantitative Real Time PCR QST	$247.20	$309.00	$247.20–$309.00	—	20%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 IgG, Type Specific Ab QST	$75.20	$94.00	$75.20–$94.00	14% above	20%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 IgM Screen QST	$75.20	$94.00	$75.20–$94.00	14% above	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 IgM Screen QST	$75.20	$94.00	$75.20–$94.00	—	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 IgG, Type Specific Ab QST	$75.20	$94.00	$75.20–$94.00	—	20%
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 IgG, Type Specific Ab QST	$75.20	$94.00	$75.20–$94.00	24% above	20%
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 IgM Screen QST	$75.20	$94.00	$75.20–$94.00	24% above	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 IgM Screen QST	$75.20	$94.00	$75.20–$94.00	—	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 IgG, Type Specific Ab QST	$75.20	$94.00	$75.20–$94.00	—	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 HS CRP QST	$48.00	$60.00	$48.00–$60.00	32% below	20%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HS CRP QST	$48.00	$60.00	$48.00–$60.00	—	20%
Homocysteine blood test CPT 83090 Homocysteine QST	$157.60	$197.00	$157.60–$197.00	44% above	20%
Homocysteine blood test inpatient CPT 83090 Homocysteine QST	$157.60	$197.00	$157.60–$197.00	—	20%
Insulin blood test CPT 83525 Insulin QST	$56.80	$71.00	$56.80–$71.00	5% below	20%
Insulin blood test inpatient CPT 83525 Insulin QST	$56.80	$71.00	$56.80–$71.00	—	20%
Iron blood test (serum iron) CPT 83540 Iron Total QST	$27.20	$34.00	$27.20–$34.00	41% below	20%
Iron blood test (serum iron) CPT 83540 Iron Level	$32.64	$40.80	$32.64–$40.80	29% below	20%
Iron blood test (serum iron) inpatient CPT 83540 Iron Total QST	$27.20	$34.00	$27.20–$34.00	—	20%
Iron blood test (serum iron) inpatient CPT 83540 Iron Level	$32.64	$40.80	$32.64–$40.80	—	20%
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity QST	$20.00	$25.00	$20.00–$25.00	70% below	20%
Iron-binding capacity (TIBC) test CPT 83550 Total Iron Binding Capacity	$60.00	$75.00	$60.00–$75.00	11% below	20%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Binding Capacity QST	$20.00	$25.00	$20.00–$25.00	—	20%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Total Iron Binding Capacity	$60.00	$75.00	$60.00–$75.00	—	20%
Kidney function blood test panel CPT 80069 Renal Pnl	$138.40	$173.00	$138.40–$173.00	30% above	20%
Kidney function blood test panel inpatient CPT 80069 Renal Pnl	$138.40	$173.00	$138.40–$173.00	—	20%
LH (luteinizing hormone) test CPT 83002 LH QST	$90.40	$113.00	$90.40–$113.00	11% below	20%
LH (luteinizing hormone) test inpatient CPT 83002 LH QST	$90.40	$113.00	$90.40–$113.00	—	20%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level	$36.00	$45.00	$36.00–$45.00	43% below	20%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Level	$36.00	$45.00	$36.00–$45.00	—	20%
Liver function blood test panel CPT 80076 Hepatic Function Panel	$101.60	$127.00	$101.60–$127.00	24% below	20%
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel	$101.60	$127.00	$101.60–$127.00	—	20%
Lyme disease antibody test CPT 86618 Lyme Disease Ab w/Rfx Blot (IgG,IgM) QST	$113.60	$142.00	$113.60–$142.00	24% above	20%
Lyme disease antibody test inpatient CPT 86618 Lyme Disease Ab w/Rfx Blot (IgG,IgM) QST	$113.60	$142.00	$113.60–$142.00	—	20%
Magnesium blood test CPT 83735 Magnesium Level	$27.20	$34.00	$27.20–$34.00	42% below	20%
Magnesium blood test CPT 83735 Magnesium, U24 QST	$44.00	$55.00	$44.00–$55.00	6% below	20%
Magnesium blood test inpatient CPT 83735 Magnesium Level	$27.20	$34.00	$27.20–$34.00	—	20%
Magnesium blood test inpatient CPT 83735 Magnesium, U24 QST	$44.00	$55.00	$44.00–$55.00	—	20%
Measles (rubeola) antibody test CPT 86765 Measles Ab (IgG) QST	$85.60	$107.00	$85.60–$107.00	45% above	20%
Measles (rubeola) antibody test inpatient CPT 86765 Measles Ab (IgG) QST	$85.60	$107.00	$85.60–$107.00	—	20%
Mono test (heterophile antibody, Monospot) CPT 86308 Mononucleosis Screen	$40.00	$50.00	$40.00–$50.00	2% below	20%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mononucleosis Screen	$40.00	$50.00	$40.00–$50.00	—	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA, Free QST	$47.20	$59.00	$47.20–$59.00	38% below	20%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA, Free QST	$47.20	$59.00	$47.20–$59.00	—	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Diagnostic	$77.60	$97.00	$77.60–$97.00	1% above	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Total QST	$77.60	$97.00	$77.60–$97.00	1% above	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Total QST	$77.60	$97.00	$77.60–$97.00	—	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Diagnostic	$77.60	$97.00	$77.60–$97.00	—	20%
Pap test (liquid-based, automated screening with review) CPT 88175 THINPREP TIS PAP Rflx HPV mRNA E6/E7 QST	$80.00	$100.00	$80.00–$100.00	8% above	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 THINPREP TIS PAP Rflx HPV mRNA E6/E7 QST	$80.00	$100.00	$80.00–$100.00	—	20%
Parathyroid hormone (PTH) blood test CPT 83970 PTH, Intact w/o Calcium QST	$140.80	$176.00	$140.80–$176.00	18% below	20%
Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone,Intact QST	$140.80	$176.00	$140.80–$176.00	18% below	20%
Parathyroid hormone (PTH) blood test CPT 83970 PTH Intact	$156.00	$195.00	$156.00–$195.00	9% below	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathyroid Hormone,Intact QST	$140.80	$176.00	$140.80–$176.00	—	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH, Intact w/o Calcium QST	$140.80	$176.00	$140.80–$176.00	—	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH Intact	$156.00	$195.00	$156.00–$195.00	—	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time	$34.40	$43.00	$34.40–$43.00	35% below	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT LA Screen QST	$34.40	$43.00	$34.40–$43.00	35% below	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT LA Screen QST	$34.40	$43.00	$34.40–$43.00	—	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time	$34.40	$43.00	$34.40–$43.00	—	20%
Progesterone blood test CPT 84144 Progesterone QST	$81.60	$102.00	$81.60–$102.00	26% below	20%
Progesterone blood test inpatient CPT 84144 Progesterone QST	$81.60	$102.00	$81.60–$102.00	—	20%
Prolactin blood test CPT 84146 Prolactin QST	$103.20	$129.00	$103.20–$129.00	16% below	20%
Prolactin blood test inpatient CPT 84146 Prolactin QST	$103.20	$129.00	$103.20–$129.00	—	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR POC	$26.40	$33.00	$26.40–$33.00	6% below	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/INR POC	$26.40	$33.00	$26.40–$33.00	—	20%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Drug Screen POC	$24.00	$30.00	$24.00–$30.00	65% below	20%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Drug Screen POC	$24.00	$30.00	$24.00–$30.00	—	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Rapid Strep POC	$27.20	$34.00	$27.20–$34.00	32% below	20%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Rapid Strep POC	$27.20	$34.00	$27.20–$34.00	—	20%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor QST	$72.00	$90.00	$72.00–$90.00	61% above	20%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Arthritis Diagnostic Identra Pnl 2 QST	$264.00	$330.00	$264.00–$330.00	492% above	20%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor QST	$72.00	$90.00	$72.00–$90.00	—	20%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Arthritis Diagnostic Identra Pnl 2 QST	$264.00	$330.00	$264.00–$330.00	—	20%
Rubella antibody test (immunity check) CPT 86762 Rubella Immune Status QST	$48.80	$61.00	$48.80–$61.00	7% below	20%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Immune Status QST	$48.80	$61.00	$48.80–$61.00	—	20%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sedimentation Rate (ESR)	$34.40	$43.00	$34.40–$43.00	at median	20%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Sedimentation Rate (ESR)	$34.40	$43.00	$34.40–$43.00	—	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Screen 1	$27.20	$34.00	$27.20–$34.00	27% above	20%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood Screen 1	$27.20	$34.00	$27.20–$34.00	—	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Hemoccult Stool POCT	$58.40	$73.00	$58.40–$73.00	15% above	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Stool for Occult Blood POCT	$58.40	$73.00	$58.40–$73.00	15% above	20%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Hemoccult Stool POCT	$58.40	$73.00	$58.40–$73.00	—	20%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Stool for Occult Blood POCT	$58.40	$73.00	$58.40–$73.00	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR (Dx) w/ Rfx Titer And Confirmatory Testing QST	$24.80	$31.00	$24.80–$31.00	16% below	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR (Dx) w/ Rfx Titer And Confirmatory Testing QST	$24.80	$31.00	$24.80–$31.00	—	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon TB Gold Plus, 4T, Incubated QST	$214.40	$268.00	$214.40–$268.00	13% above	20%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Quantiferon TB Gold Plus, 4T, Incubated QST	$214.40	$268.00	$214.40–$268.00	—	20%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Total, LC/MS/MS QST	$125.60	$157.00	$125.60–$157.00	6% above	20%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Total, MS QST	$125.60	$157.00	$125.60–$157.00	6% above	20%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Ttl, Males (Adult), Immunoassay QST	$125.60	$157.00	$125.60–$157.00	6% above	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Ttl, Males (Adult), Immunoassay QST	$125.60	$157.00	$125.60–$157.00	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Total, LC/MS/MS QST	$125.60	$157.00	$125.60–$157.00	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Total, MS QST	$125.60	$157.00	$125.60–$157.00	—	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Antibodies QST	$76.80	$96.00	$76.80–$96.00	at median	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Abs QST	$76.80	$96.00	$76.80–$96.00	at median	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Abs QST	$76.80	$96.00	$76.80–$96.00	—	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Antibodies QST	$76.80	$96.00	$76.80–$96.00	—	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH w/ Rflx to Free T4	$74.40	$93.00	$74.40–$93.00	62% above	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone	$74.40	$93.00	$74.40–$93.00	62% above	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH w/ Rflx to Free T4	$74.40	$93.00	$74.40–$93.00	—	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone	$74.40	$93.00	$74.40–$93.00	—	20%
Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginalis RNA, Ql, Male QST	$224.00	$280.00	$224.00–$280.00	63% above	20%
Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginalis RNA, Ql, TMA QST	$224.00	$280.00	$224.00–$280.00	63% above	20%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas Vaginalis RNA, Ql, TMA QST	$224.00	$280.00	$224.00–$280.00	—	20%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas Vaginalis RNA, Ql, Male QST	$224.00	$280.00	$224.00–$280.00	—	20%
Uric acid blood test CPT 84550 Uric Acid	$27.20	$34.00	$27.20–$34.00	36% below	20%
Uric acid blood test inpatient CPT 84550 Uric Acid	$27.20	$34.00	$27.20–$34.00	—	20%
Urinalysis with microscope exam, automated CPT 81001 UA w Micro	$34.40	$43.00	$34.40–$43.00	8% below	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA w Micro	$34.40	$43.00	$34.40–$43.00	—	20%
Urinalysis with microscope exam, manual CPT 81000 Reducing Substances Urine	$34.40	$43.00	$34.40–$43.00	6% above	20%
Urinalysis with microscope exam, manual inpatient CPT 81000 Reducing Substances Urine	$34.40	$43.00	$34.40–$43.00	—	20%
Urinalysis without microscope exam, automated CPT 81003 Urine Dipstick POC	$20.00	$25.00	$20.00–$25.00	at median	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Dipstick POC	$20.00	$25.00	$20.00–$25.00	—	20%
Urinalysis without microscope exam, manual CPT 81002 Ketones Urine	$27.20	$34.00	$27.20–$34.00	109% above	20%
Urinalysis without microscope exam, manual inpatient CPT 81002 Ketones Urine	$27.20	$34.00	$27.20–$34.00	—	20%
Urine culture for bacteria, with colony count CPT 87086 Culture, Urine Routine QST	$50.40	$63.00	$50.40–$63.00	22% below	20%
Urine culture for bacteria, with colony count CPT 87086 Culture, Urine Special QST	$50.40	$63.00	$50.40–$63.00	22% below	20%
Urine culture for bacteria, with colony count inpatient CPT 87086 Culture, Urine Special QST	$50.40	$63.00	$50.40–$63.00	—	20%
Urine culture for bacteria, with colony count inpatient CPT 87086 Culture, Urine Routine QST	$50.40	$63.00	$50.40–$63.00	—	20%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Level	$56.80	$71.00	$56.80–$71.00	26% below	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Level	$56.80	$71.00	$56.80–$71.00	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 25-OH Vit D (D2,D3), LC/MS/MS QST	$201.60	$252.00	$201.60–$252.00	48% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D,25-Oh QST	$201.60	$252.00	$201.60–$252.00	48% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 Hydroxy Level	$221.60	$277.00	$221.60–$277.00	63% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 25-OH Vit D (D2,D3), LC/MS/MS QST	$201.60	$252.00	$201.60–$252.00	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D,25-Oh QST	$201.60	$252.00	$201.60–$252.00	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25 Hydroxy Level	$221.60	$277.00	$221.60–$277.00	—	20%
Zinc blood test CPT 84630 Zinc QST	$54.40	$68.00	$54.40–$68.00	11% below	20%
Zinc blood test inpatient CPT 84630 Zinc QST	$54.40	$68.00	$54.40–$68.00	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta hCG Quantitative	$85.60	$107.00	$85.60–$107.00	1% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Beta hCG Quantitative	$85.60	$107.00	$85.60–$107.00	—	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
Adenoid removal (adenoidectomy), child under 12 CPT 42830 42830 ADENOIDECTOMY, PRIMARY; YOUNGER THAN AGE 12 ProFee	$256.80	$321.00	$256.80–$321.00	92% below	20%
Adenoid removal (adenoidectomy), child under 12 CPT 42830 42830 Adenoidectomy, Primary; younger than age 12	$5,600.00	$7,000.00	$5,600.00–$7,000.00	74% above	20%
Adenoid removal (adenoidectomy), child under 12 inpatient CPT 42830 42830 ADENOIDECTOMY, PRIMARY; YOUNGER THAN AGE 12 ProFee	$256.80	$321.00	$256.80–$321.00	—	20%
Adenoid removal (adenoidectomy), child under 12 inpatient CPT 42830 42830 Adenoidectomy, Primary; younger than age 12	$5,600.00	$7,000.00	$5,600.00–$7,000.00	—	20%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 29888 Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction	$1,088.00	$1,360.00	$1,088.00–$1,360.00	94% below	20%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 29888 ACL RECON W ANTERIOR TIBIALIS ALLOGRAPH	$7,600.00	$9,500.00	$7,600.00–$9,500.00	61% below	20%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 29888 Arthroscopically Aided Anterior Cruciate Ligament Repair, Augmentation/Reconstruction of knee	$12,000.00	$15,000.00	$12,000.00–$15,000.00	38% below	20%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 29888 Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction	$1,088.00	$1,360.00	$1,088.00–$1,360.00	—	20%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 29888 ACL RECON W ANTERIOR TIBIALIS ALLOGRAPH	$7,600.00	$9,500.00	$7,600.00–$9,500.00	—	20%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 29888 Arthroscopically Aided Anterior Cruciate Ligament Repair, Augmentation/Reconstruction of knee	$12,000.00	$15,000.00	$12,000.00–$15,000.00	—	20%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 29827 Arthroscopy, shoulder, surgical; with rotator cuff repair	$1,264.00	$1,580.00	$1,264.00–$1,580.00	90% below	20%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 29827 SHOULDER ARTHROSCOPY ROTATOR CUFF REPAIR	$17,663.20	$22,079.00	$17,663.20–$22,079.00	46% above	20%
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 29827 Arthroscopy, shoulder, surgical; with rotator cuff repair	$1,264.00	$1,580.00	$1,264.00–$1,580.00	—	20%
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 29827 SHOULDER ARTHROSCOPY ROTATOR CUFF REPAIR	$17,663.20	$22,079.00	$17,663.20–$22,079.00	—	20%
Balloon dilation of the maxillary sinus opening, one side CPT 31295 31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ostium (eg, balloon dilation	$14,048.80	$17,561.00	$14,048.80–$17,561.00	40% above	20%
Balloon dilation of the maxillary sinus opening, one side inpatient CPT 31295 31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ostium (eg, balloon dilation	$14,048.80	$17,561.00	$14,048.80–$17,561.00	—	20%
Botox injections for chronic migraine both sides CPT 64615 64615 Chemodenervation of muscle(s); muscle(s) innervated nerves, bilateral	$520.00	$650.00	$520.00–$650.00	—	20%
Botox injections for chronic migraine both sides CPT 64615 64615 CHEMODENERVATION CERVICAL SPINAL BI CHARGE	$520.00	$650.00	$520.00–$650.00	—	20%
Botox injections for chronic migraine CPT 64615 64615 CHEMODENERVATION OF MUSCLE(S); MUSCLE(S) INNERVATED BY FACIAL, TRIGEMINAL, CERVICAL SP ProFee	$260.00	$325.00	$260.00–$325.00	at median	20%
Botox injections for chronic migraine inpatient both sides CPT 64615 64615 CHEMODENERVATION CERVICAL SPINAL BI CHARGE	$520.00	$650.00	$520.00–$650.00	—	20%
Botox injections for chronic migraine inpatient both sides CPT 64615 64615 Chemodenervation of muscle(s); muscle(s) innervated nerves, bilateral	$520.00	$650.00	$520.00–$650.00	—	20%
Botox injections for chronic migraine inpatient CPT 64615 64615 CHEMODENERVATION OF MUSCLE(S); MUSCLE(S) INNERVATED BY FACIAL, TRIGEMINAL, CERVICAL SP ProFee	$260.00	$325.00	$260.00–$325.00	—	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786-Distal Fibular w/o Manipulation	$185.60	$232.00	$185.60–$232.00	62% below	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786 CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ TechFee	$185.60	$232.00	$185.60–$232.00	62% below	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786 Closed treatment of distal fibular fracture (lateral malleolus); without manipulation	$513.60	$642.00	$513.60–$642.00	5% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 27786-Distal Fibular w/o Manipulation	$185.60	$232.00	$185.60–$232.00	—	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 27786 CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ TechFee	$185.60	$232.00	$185.60–$232.00	—	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 27786 Closed treatment of distal fibular fracture (lateral malleolus); without manipulation	$513.60	$642.00	$513.60–$642.00	—	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 28470 CLOSED TX METATARSAL FRACTURE W/O MANIPULATION TechFee	$185.60	$232.00	$185.60–$232.00	53% below	20%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 28470 CLOSED TX METATARSAL FRACTURE W/O MANIPULATION TechFee	$185.60	$232.00	$185.60–$232.00	—	20%
Bunion correction with removal of part of the big toe joint CPT 28292 28292 Correction, hallux valgus (bunion), w/ or w/o sesamoidectomy; Keller, Mayo type procedure	$622.40	$778.00	$622.40–$778.00	47% below	20%
Bunion correction with removal of part of the big toe joint CPT 28292 28292 BUNIONECTOMY WITH RESECTION	$2,320.00	$2,900.00	$2,320.00–$2,900.00	97% above	20%
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 28292 Correction, hallux valgus (bunion), w/ or w/o sesamoidectomy; Keller, Mayo type procedure	$622.40	$778.00	$622.40–$778.00	—	20%
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 28292 BUNIONECTOMY WITH RESECTION	$2,320.00	$2,900.00	$2,320.00–$2,900.00	—	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL TechFee	$384.00	$480.00	$384.00–$480.00	53% below	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 - Cardioversion; Elective	$384.00	$480.00	$384.00–$480.00	53% below	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 92960 - Cardioversion; Elective	$384.00	$480.00	$384.00–$480.00	—	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL TechFee	$384.00	$480.00	$384.00–$480.00	—	20%
Carpal tunnel release, open surgery CPT 64721 64721 NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL ProFee	$577.60	$722.00	$577.60–$722.00	81% below	20%
Carpal tunnel release, open surgery CPT 64721 64721 CARPAL TUN.DECOMPRES	$2,149.60	$2,687.00	$2,149.60–$2,687.00	29% below	20%
Carpal tunnel release, open surgery inpatient CPT 64721 64721 NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL ProFee	$577.60	$722.00	$577.60–$722.00	—	20%
Carpal tunnel release, open surgery inpatient CPT 64721 64721 CARPAL TUN.DECOMPRES	$2,149.60	$2,687.00	$2,149.60–$2,687.00	—	20%
Cataract surgery with lens implant CPT 66984 66984 CATARACT EXTRACT W/IOL	$2,655.20	$3,319.00	$2,655.20–$3,319.00	49% below	20%
Cataract surgery with lens implant inpatient CPT 66984 66984 CATARACT EXTRACT W/IOL	$2,655.20	$3,319.00	$2,655.20–$3,319.00	—	20%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 54161 Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28days	$3,600.00	$4,500.00	$3,600.00–$4,500.00	13% above	20%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 54161 Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28days	$3,600.00	$4,500.00	$3,600.00–$4,500.00	—	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 54150 Circumcision, using clamp or other device with regional dorsal penile or ring block	$251.20	$314.00	$251.20–$314.00	25% below	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 54150 Circumcision, using clamp or other device with regional dorsal penile or ring block	$251.20	$314.00	$251.20–$314.00	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 Closed treatment of distal radial fracture without manipulation	$316.80	$396.00	$316.80–$396.00	46% below	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ TechFee	$376.80	$471.00	$376.80–$471.00	36% below	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600-Distal Radial w/o Manipulation	$376.80	$471.00	$376.80–$471.00	36% below	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 25600 Closed treatment of distal radial fracture without manipulation	$316.80	$396.00	$316.80–$396.00	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ TechFee	$376.80	$471.00	$376.80–$471.00	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 25600-Distal Radial w/o Manipulation	$376.80	$471.00	$376.80–$471.00	—	20%
Colonoscopy with polyp removal CPT 45385 45385 COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE ProFee	$607.20	$759.00	$607.20–$759.00	64% below	20%
Colonoscopy with polyp removal CPT 45385 45385 COLONSCOPY W/SNARE	$1,273.60	$1,592.00	$1,273.60–$1,592.00	25% below	20%
Colonoscopy with polyp removal inpatient CPT 45385 45385 COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE ProFee	$607.20	$759.00	$607.20–$759.00	—	20%
Colonoscopy with polyp removal inpatient CPT 45385 45385 COLONSCOPY W/SNARE	$1,273.60	$1,592.00	$1,273.60–$1,592.00	—	20%
Colonoscopy with tissue sample CPT 45380 45380 COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE ProFee	$445.60	$557.00	$445.60–$557.00	75% below	20%
Colonoscopy with tissue sample CPT 45380 45380 COLONOSCOPY W/BIOPSY	$1,120.00	$1,400.00	$1,120.00–$1,400.00	37% below	20%
Colonoscopy with tissue sample inpatient CPT 45380 45380 COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE ProFee	$445.60	$557.00	$445.60–$557.00	—	20%
Colonoscopy with tissue sample inpatient CPT 45380 45380 COLONOSCOPY W/BIOPSY	$1,120.00	$1,400.00	$1,120.00–$1,400.00	—	20%
Colonoscopy, diagnostic CPT 45378 45378 COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR ProFee	$398.40	$498.00	$398.40–$498.00	69% below	20%
Colonoscopy, diagnostic CPT 45378 45378 Colonoscopy Surgery Charge	$996.00	$1,245.00	$996.00–$1,245.00	21% below	20%
Colonoscopy, diagnostic inpatient CPT 45378 45378 COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR ProFee	$398.40	$498.00	$398.40–$498.00	—	20%
Colonoscopy, diagnostic inpatient CPT 45378 45378 Colonoscopy Surgery Charge	$996.00	$1,245.00	$996.00–$1,245.00	—	20%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 57454 Colposcopy of the cervix incl. vagina w/ biopsy of cervix and endocervical curettage	$292.80	$366.00	$292.80–$366.00	35% below	20%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 57454 Colposcopy of the cervix incl. vagina w/ biopsy of cervix and endocervical curettage	$292.80	$366.00	$292.80–$366.00	—	20%
Complex cataract surgery with lens implant CPT 66982 66982 CAT EXT W/IRIS RETRACTOR	$2,470.40	$3,088.00	$2,470.40–$3,088.00	44% below	20%
Complex cataract surgery with lens implant inpatient CPT 66982 66982 CAT EXT W/IRIS RETRACTOR	$2,470.40	$3,088.00	$2,470.40–$3,088.00	—	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 52000 Cystourethroscopy (separate procedure)	$326.40	$408.00	$326.40–$408.00	70% below	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 52000 Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope	$1,400.00	$1,750.00	$1,400.00–$1,750.00	31% above	20%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 52000 Cystourethroscopy (separate procedure)	$326.40	$408.00	$326.40–$408.00	—	20%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 52000 Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope	$1,400.00	$1,750.00	$1,400.00–$1,750.00	—	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 17000 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettemen	$120.00	$150.00	$120.00–$150.00	3% above	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 17000 Destruction, premalignant lesions; Initial	$1,040.00	$1,300.00	$1,040.00–$1,300.00	789% above	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 17000 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettemen	$120.00	$150.00	$120.00–$150.00	—	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 17000 Destruction, premalignant lesions; Initial	$1,040.00	$1,300.00	$1,040.00–$1,300.00	—	20%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 69436 TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), GENERAL ANESTHESIA ProFee	$209.60	$262.00	$209.60–$262.00	94% below	20%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 69436 Tympanostomy (requiring insertion of ventilation tube), general anesthesia	$2,400.00	$3,000.00	$2,400.00–$3,000.00	27% below	20%
Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 69436 TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), GENERAL ANESTHESIA ProFee	$209.60	$262.00	$209.60–$262.00	—	20%
Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 69436 Tympanostomy (requiring insertion of ventilation tube), general anesthesia	$2,400.00	$3,000.00	$2,400.00–$3,000.00	—	20%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 69433 Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia	$411.20	$514.00	$411.20–$514.00	at median	20%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 69433 Tympanostomy (requiring insertion of ventilating tube); local or top anes	$1,376.80	$1,721.00	$1,376.80–$1,721.00	234% above	20%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 69433 Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia	$411.20	$514.00	$411.20–$514.00	—	20%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 69433 Tympanostomy (requiring insertion of ventilating tube); local or top anes	$1,376.80	$1,721.00	$1,376.80–$1,721.00	—	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 69209 Ear Irrigation POC	$80.00	$100.00	$80.00–$100.00	8% above	20%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL TechFee	$200.00	$250.00	$200.00–$250.00	170% above	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 69209 Ear Irrigation POC	$80.00	$100.00	$80.00–$100.00	—	20%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL TechFee	$200.00	$250.00	$200.00–$250.00	—	20%
Earwax removal with instruments, one ear CPT 69210 69210-Cerumen w/ Instrumentation	$371.20	$464.00	$371.20–$464.00	305% above	20%
Earwax removal with instruments, one ear one side CPT 69210 69210 Removal impacted cerumen requiring instrumentation, unilateral	$44.00	$55.00	$44.00–$55.00	52% below	20%
Earwax removal with instruments, one ear one side CPT 69210 69210 Removal impacted cerumen requiring instrumentation; unilateral	$199.20	$249.00	$199.20–$249.00	117% above	20%
Earwax removal with instruments, one ear one side CPT 69210 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT TechFee	$371.20	$464.00	$371.20–$464.00	305% above	20%
Earwax removal with instruments, one ear inpatient CPT 69210 69210-Cerumen w/ Instrumentation	$371.20	$464.00	$371.20–$464.00	—	20%
Earwax removal with instruments, one ear inpatient one side CPT 69210 69210 Removal impacted cerumen requiring instrumentation, unilateral	$44.00	$55.00	$44.00–$55.00	—	20%
Earwax removal with instruments, one ear inpatient one side CPT 69210 69210 Removal impacted cerumen requiring instrumentation; unilateral	$199.20	$249.00	$199.20–$249.00	—	20%
Earwax removal with instruments, one ear inpatient one side CPT 69210 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT TechFee	$371.20	$464.00	$371.20–$464.00	—	20%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 31256 EXPLORATION MAXILLARY SINUS	$333.60	$417.00	$333.60–$417.00	89% below	20%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus inpatient CPT 31256 31256 EXPLORATION MAXILLARY SINUS	$333.60	$417.00	$333.60–$417.00	—	20%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 31267 Nasal/sinus endoscopy, surgical, w/ maxillary antrostomy; w/ removal of tissue from sinus	$8,128.80	$10,161.00	$8,128.80–$10,161.00	at median	20%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 31267 Nasal/sinus endoscopy, surgical; with maxillary antrostomy PIKE	$16,580.80	$20,726.00	$16,580.80–$20,726.00	104% above	20%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient CPT 31267 31267 Nasal/sinus endoscopy, surgical, w/ maxillary antrostomy; w/ removal of tissue from sinus	$8,128.80	$10,161.00	$8,128.80–$10,161.00	—	20%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient CPT 31267 31267 Nasal/sinus endoscopy, surgical; with maxillary antrostomy PIKE	$16,580.80	$20,726.00	$16,580.80–$20,726.00	—	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 62321 INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC ProFee	$200.00	$250.00	$200.00–$250.00	80% below	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 62321 INJ CERVICAL/THORACIC EPIDURAL W IMAGE	$796.80	$996.00	$796.80–$996.00	22% below	20%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 62321 INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC ProFee	$200.00	$250.00	$200.00–$250.00	—	20%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 62321 INJ CERVICAL/THORACIC EPIDURAL W IMAGE	$796.80	$996.00	$796.80–$996.00	—	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 64493 INJ PARAVERTBRALLUMBAR	$741.60	$927.00	$741.60–$927.00	28% below	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 64493 INJ PARAVERTBRALLUMBAR	$741.60	$927.00	$741.60–$927.00	—	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 49591 Repair of hernia with mesh, less than 3 cm, reducible	$9,052.80	$11,316.00	$9,052.80–$11,316.00	92% above	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 49591 Repair of hernia with mesh, less than 3 cm, reducible	$9,052.80	$11,316.00	$9,052.80–$11,316.00	—	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 45330 SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING O ProFee	$112.00	$140.00	$112.00–$140.00	90% below	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 45330 SIGMOIDOSCOPY	$603.20	$754.00	$603.20–$754.00	47% below	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 45330 SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING O ProFee	$112.00	$140.00	$112.00–$140.00	—	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 45330 SIGMOIDOSCOPY	$603.20	$754.00	$603.20–$754.00	—	20%
Gallbladder removal, laparoscopic CPT 47562 47562 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY ProFee	$960.00	$1,200.00	$960.00–$1,200.00	84% below	20%
Gallbladder removal, laparoscopic CPT 47562 47562 LAP CHOLECY	$3,942.40	$4,928.00	$3,942.40–$4,928.00	35% below	20%
Gallbladder removal, laparoscopic inpatient CPT 47562 47562 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY ProFee	$960.00	$1,200.00	$960.00–$1,200.00	—	20%
Gallbladder removal, laparoscopic inpatient CPT 47562 47562 LAP CHOLECY	$3,942.40	$4,928.00	$3,942.40–$4,928.00	—	20%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 47563 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY ProFee	$1,075.20	$1,344.00	$1,075.20–$1,344.00	83% below	20%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 47563 LAP CHOLE W/CHOLANGIOGRM	$3,942.40	$4,928.00	$3,942.40–$4,928.00	37% below	20%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 47563 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY ProFee	$1,075.20	$1,344.00	$1,075.20–$1,344.00	—	20%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 47563 LAP CHOLE W/CHOLANGIOGRM	$3,942.40	$4,928.00	$3,942.40–$4,928.00	—	20%
Hammertoe correction surgery CPT 28285 28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)	$600.00	$750.00	$600.00–$750.00	75% below	20%
Hammertoe correction surgery CPT 28285 28285 HAMMERTOES CORR/UNI	$1,704.00	$2,130.00	$1,704.00–$2,130.00	29% below	20%
Hammertoe correction surgery inpatient CPT 28285 28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)	$600.00	$750.00	$600.00–$750.00	—	20%
Hammertoe correction surgery inpatient CPT 28285 28285 HAMMERTOES CORR/UNI	$1,704.00	$2,130.00	$1,704.00–$2,130.00	—	20%
Hemorrhoid banding (rubber band ligation) CPT 46221 46221 HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S) ProFee	$227.20	$284.00	$227.20–$284.00	83% below	20%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 46221 HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S) ProFee	$227.20	$284.00	$227.20–$284.00	—	20%
Hip replacement after an earlier hip surgery (conversion to total hip) inpatient CPT 27132 27132 Conversion of previous hip surgery to total hip arthroplasty	$2,614.40	$3,268.00	$2,614.40–$3,268.00	—	20%
IUD insertion (the device itself billed separately) CPT 58300 58300 Insertion of intrauterine device (IUD)	$128.00	$160.00	$128.00–$160.00	79% below	20%
IUD insertion (the device itself billed separately) inpatient CPT 58300 58300 Insertion of intrauterine device (IUD)	$128.00	$160.00	$128.00–$160.00	—	20%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 Incision and drainage of abscess simple or single	$91.20	$114.00	$91.20–$114.00	59% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE TechFee	$147.20	$184.00	$147.20–$184.00	35% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 10060-I&D Abscess/Cyst/Hematoma Simple	$147.20	$184.00	$147.20–$184.00	35% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 1910060A SIMPLE I & D CHARGE	$147.20	$184.00	$147.20–$184.00	35% below	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 10060 Incision and drainage of abscess simple or single	$91.20	$114.00	$91.20–$114.00	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 10060-I&D Abscess/Cyst/Hematoma Simple	$147.20	$184.00	$147.20–$184.00	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE TechFee	$147.20	$184.00	$147.20–$184.00	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 1910060A SIMPLE I & D CHARGE	$147.20	$184.00	$147.20–$184.00	—	20%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 49505 REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE ProFee	$623.20	$779.00	$623.20–$779.00	90% below	20%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 49505 INGUINAL HERNIA	$2,605.60	$3,257.00	$2,605.60–$3,257.00	58% below	20%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 49505 REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE ProFee	$623.20	$779.00	$623.20–$779.00	—	20%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 49505 INGUINAL HERNIA	$2,605.60	$3,257.00	$2,605.60–$3,257.00	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar fascia)	$88.00	$110.00	$88.00–$110.00	56% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 20550 Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar fascia)	$88.00	$110.00	$88.00–$110.00	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 Arthrocentesis aspiration and/or injection major joint or bursa without ultrasound guidance	$120.00	$150.00	$120.00–$150.00	44% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610-Major Joint Aspirate/Inject w/o US	$711.20	$889.00	$711.20–$889.00	233% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 JOINT INJ/ ASP MAJOR	$719.20	$899.00	$719.20–$899.00	236% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610 Arthrocentesis aspiration and/or injection major joint or bursa without ultrasound guidance	$120.00	$150.00	$120.00–$150.00	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610-Major Joint Aspirate/Inject w/o US	$711.20	$889.00	$711.20–$889.00	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610 JOINT INJ/ ASP MAJOR	$719.20	$899.00	$719.20–$899.00	—	20%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 11981 Insertion, non biodegradable drug delivery implant	$116.00	$145.00	$116.00–$145.00	36% below	20%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 11981 Insertion, non biodegradable drug delivery implant	$116.00	$145.00	$116.00–$145.00	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa	$57.60	$72.00	$57.60–$72.00	71% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 INTERMEDIATE JOINT INJ ELBOW WRIST	$256.00	$320.00	$256.00–$320.00	28% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa	$57.60	$72.00	$57.60–$72.00	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 20605 INTERMEDIATE JOINT INJ ELBOW WRIST	$256.00	$320.00	$256.00–$320.00	—	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes)	$55.20	$69.00	$55.20–$69.00	73% below	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 INJ JOINT/BURSA SMALL	$198.40	$248.00	$198.40–$248.00	1% below	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes)	$55.20	$69.00	$55.20–$69.00	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 20600 INJ JOINT/BURSA SMALL	$198.40	$248.00	$198.40–$248.00	—	20%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 29882 Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral)	$976.00	$1,220.00	$976.00–$1,220.00	91% below	20%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 29882 ARTHROSCOPIC MENISCUS REPAIR MEDL OR LAT	$2,800.00	$3,500.00	$2,800.00–$3,500.00	74% below	20%
Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 29882 Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral)	$976.00	$1,220.00	$976.00–$1,220.00	—	20%
Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 29882 ARTHROSCOPIC MENISCUS REPAIR MEDL OR LAT	$2,800.00	$3,500.00	$2,800.00–$3,500.00	—	20%
Knee arthroscopy with meniscus trim CPT 29881 29881 Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral) including chondroplasty	$877.60	$1,097.00	$877.60–$1,097.00	87% below	20%
Knee arthroscopy with meniscus trim CPT 29881 29881 KNEE ARTHRO W/MENISCECTMY MED OR LAT	$2,644.80	$3,306.00	$2,644.80–$3,306.00	62% below	20%
Knee arthroscopy with meniscus trim inpatient CPT 29881 29881 Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral) including chondroplasty	$877.60	$1,097.00	$877.60–$1,097.00	—	20%
Knee arthroscopy with meniscus trim inpatient CPT 29881 29881 KNEE ARTHRO W/MENISCECTMY MED OR LAT	$2,644.80	$3,306.00	$2,644.80–$3,306.00	—	20%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 29880 Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral) including chondroplasty	$1,180.00	$1,475.00	$1,180.00–$1,475.00	83% below	20%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 29880 ARTHROSCOPY-MENISCECTOMY MEDIAL AND LAT	$7,668.80	$9,586.00	$7,668.80–$9,586.00	11% above	20%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 29880 Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral) including chondroplasty	$1,180.00	$1,475.00	$1,180.00–$1,475.00	—	20%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 29880 ARTHROSCOPY-MENISCECTOMY MEDIAL AND LAT	$7,668.80	$9,586.00	$7,668.80–$9,586.00	—	20%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)	$8,269.60	$10,337.00	$8,269.60–$10,337.00	33% above	20%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 29877 Arthro, knee, surg; abrasion arthroplasty (inc. chondroplasty) drilling/microfracture	$8,269.60	$10,337.00	$8,269.60–$10,337.00	33% above	20%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)	$8,269.60	$10,337.00	$8,269.60–$10,337.00	—	20%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 29877 Arthro, knee, surg; abrasion arthroplasty (inc. chondroplasty) drilling/microfracture	$8,269.60	$10,337.00	$8,269.60–$10,337.00	—	20%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 66821 YAG/LASER CAPSULOTOM	$710.40	$888.00	$710.40–$888.00	at median	20%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 66821 YAG/LASER CAPSULOTOM	$710.40	$888.00	$710.40–$888.00	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 Layered closure, scalp, axillae, trunk and/or extremities </= 2.5 CM	$204.80	$256.00	$204.80–$256.00	46% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< TechFee	$208.00	$260.00	$208.00–$260.00	45% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031-Scalp/Trunk/Extremity Less Than/Equal to 2.5 cm	$208.00	$260.00	$208.00–$260.00	45% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 Repair, intermediate; wounds of scalp, axillae, trunk, extremities; <2.5cm	$278.40	$348.00	$278.40–$348.00	27% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 12031 Layered closure, scalp, axillae, trunk and/or extremities </= 2.5 CM	$204.80	$256.00	$204.80–$256.00	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< TechFee	$208.00	$260.00	$208.00–$260.00	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 12031-Scalp/Trunk/Extremity Less Than/Equal to 2.5 cm	$208.00	$260.00	$208.00–$260.00	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 12031 Repair, intermediate; wounds of scalp, axillae, trunk, extremities; <2.5cm	$278.40	$348.00	$278.40–$348.00	—	20%
Lower-back epidural injection, with imaging guidance CPT 62323 62323 INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC ProFee	$176.00	$220.00	$176.00–$220.00	82% below	20%
Lower-back epidural injection, with imaging guidance CPT 62323 62323 EPIDURAL STEROID INJ W IMAGE	$764.00	$955.00	$764.00–$955.00	21% below	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 62323 INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC ProFee	$176.00	$220.00	$176.00–$220.00	—	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 62323 EPIDURAL STEROID INJ W IMAGE	$764.00	$955.00	$764.00–$955.00	—	20%
Lower-back epidural injection, without imaging guidance CPT 62322 62322 INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC ProFee	$156.00	$195.00	$156.00–$195.00	86% below	20%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 62322 INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC ProFee	$156.00	$195.00	$156.00–$195.00	—	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 64483 INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, WITH IMAGING G ProFee	$260.80	$326.00	$260.80–$326.00	83% below	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 64483 TRANSFORAMINAL ESI	$741.60	$927.00	$741.60–$927.00	50% below	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 64483 INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, WITH IMAGING G ProFee	$260.80	$326.00	$260.80–$326.00	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 64483 TRANSFORAMINAL ESI	$741.60	$927.00	$741.60–$927.00	—	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400 Excision, benign lesion including margins; trunk, arms or legs; < 0.5cm	$184.80	$231.00	$184.80–$231.00	25% below	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400 Excision Benign Lesion (trunk, arms, or legs) </= 0.5 CM	$668.80	$836.00	$668.80–$836.00	171% above	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 11400 Excision, benign lesion including margins; trunk, arms or legs; < 0.5cm	$184.80	$231.00	$184.80–$231.00	—	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 11400 Excision Benign Lesion (trunk, arms, or legs) </= 0.5 CM	$668.80	$836.00	$668.80–$836.00	—	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 11440 Excision, benign lesion including margins; face, ears, eyelids, nose, lips; < 0.5cm	$123.20	$154.00	$123.20–$154.00	57% below	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 11440 EXC B-FACE 0.5OR<CM	$668.80	$836.00	$668.80–$836.00	132% above	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 11440 Excision, benign lesion including margins; face, ears, eyelids, nose, lips; < 0.5cm	$123.20	$154.00	$123.20–$154.00	—	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 11440 EXC B-FACE 0.5OR<CM	$668.80	$836.00	$668.80–$836.00	—	20%
Nail removal (partial or complete), one nail CPT 11730 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 TechFee	$78.40	$98.00	$78.40–$98.00	52% below	20%
Nail removal (partial or complete), one nail CPT 11730 11730-Avulsion Nail Plate Single	$78.40	$98.00	$78.40–$98.00	52% below	20%
Nail removal (partial or complete), one nail CPT 11730 11730 Avulsion of nail plate, partial or complete, simple; single	$84.00	$105.00	$84.00–$105.00	49% below	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 11730-Avulsion Nail Plate Single	$78.40	$98.00	$78.40–$98.00	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 TechFee	$78.40	$98.00	$78.40–$98.00	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 11730 Avulsion of nail plate, partial or complete, simple; single	$84.00	$105.00	$84.00–$105.00	—	20%
Occipital nerve block (injection for headaches) CPT 64405 64405 INJECTION, ANESTHETIC AGENT; GREATER OCCIPITAL NERVE ProFee	$98.40	$123.00	$98.40–$123.00	68% below	20%
Occipital nerve block (injection for headaches) CPT 64405 64405 Injection, anesthetic agent; greater occipital nerve	$200.00	$250.00	$200.00–$250.00	34% below	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 64405 INJECTION, ANESTHETIC AGENT; GREATER OCCIPITAL NERVE ProFee	$98.40	$123.00	$98.40–$123.00	—	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 64405 Injection, anesthetic agent; greater occipital nerve	$200.00	$250.00	$200.00–$250.00	—	20%
Paracentesis with imaging guidance CPT 49083 49083-Abdominal Paracentesis w/ Imaging Guide	$2,408.80	$3,011.00	$2,408.80–$3,011.00	179% above	20%
Paracentesis with imaging guidance CPT 49083 49083 PARACENTESIS/LAVAGE WITH IMAGING	$2,408.80	$3,011.00	$2,408.80–$3,011.00	179% above	20%
Paracentesis with imaging guidance inpatient CPT 49083 49083-Abdominal Paracentesis w/ Imaging Guide	$2,408.80	$3,011.00	$2,408.80–$3,011.00	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 49083 PARACENTESIS/LAVAGE WITH IMAGING	$2,408.80	$3,011.00	$2,408.80–$3,011.00	—	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 Excision of nail and nail matrix, partial or complete, for permanent removal	$280.00	$350.00	$280.00–$350.00	29% below	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750-Excision Nail & Matrix	$536.00	$670.00	$536.00–$670.00	35% above	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 11750 Excision of nail and nail matrix, partial or complete, for permanent removal	$280.00	$350.00	$280.00–$350.00	—	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 11750-Excision Nail & Matrix	$536.00	$670.00	$536.00–$670.00	—	20%
Removal of a breast lump, open surgery CPT 19120 19120 Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue	$612.80	$766.00	$612.80–$766.00	38% below	20%
Removal of a breast lump, open surgery inpatient CPT 19120 19120 Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue	$612.80	$766.00	$612.80–$766.00	—	20%
Removal of a foreign object under the skin, simple CPT 10120 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE TechFee	$172.00	$215.00	$172.00–$215.00	44% below	20%
Removal of a foreign object under the skin, simple CPT 10120 10120-Subcutaneous Tissue Simple	$172.00	$215.00	$172.00–$215.00	44% below	20%
Removal of a foreign object under the skin, simple CPT 10120 10120 Incision and removal of foreign body, subcutaneous tissues; simple	$197.60	$247.00	$197.60–$247.00	35% below	20%
Removal of a foreign object under the skin, simple CPT 10120 10120 FB INCISION/REMOVAL	$668.80	$836.00	$668.80–$836.00	120% above	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 10120-Subcutaneous Tissue Simple	$172.00	$215.00	$172.00–$215.00	—	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE TechFee	$172.00	$215.00	$172.00–$215.00	—	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 10120 Incision and removal of foreign body, subcutaneous tissues; simple	$197.60	$247.00	$197.60–$247.00	—	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 10120 FB INCISION/REMOVAL	$668.80	$836.00	$668.80–$836.00	—	20%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk	$398.40	$498.00	$398.40–$498.00	48% below	20%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk	$398.40	$498.00	$398.40–$498.00	—	20%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 G0105 Colorectal cancer screening; colonoscopy on individual at high risk	$398.40	$498.00	$398.40–$498.00	47% below	20%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 G0105 Colorectal cancer screening; colonoscopy on individual at high risk	$398.40	$498.00	$398.40–$498.00	—	20%
Septoplasty to straighten the nasal septum CPT 30520 30520 REPAIR OF NASAL SEPTUM	$5,480.00	$6,850.00	$5,480.00–$6,850.00	19% below	20%
Septoplasty to straighten the nasal septum CPT 30520 30520 Septoplasty or submucous resection, w/ or w/o cartilage scoring/contouring/replcmnt w/ graft	$8,197.60	$10,247.00	$8,197.60–$10,247.00	21% above	20%
Septoplasty to straighten the nasal septum inpatient CPT 30520 30520 REPAIR OF NASAL SEPTUM	$5,480.00	$6,850.00	$5,480.00–$6,850.00	—	20%
Septoplasty to straighten the nasal septum inpatient CPT 30520 30520 Septoplasty or submucous resection, w/ or w/o cartilage scoring/contouring/replcmnt w/ graft	$8,197.60	$10,247.00	$8,197.60–$10,247.00	—	20%
Short arm cast (elbow to hand) CPT 29075 29075 Application, cast; elbow to finger (short arm)	$138.40	$173.00	$138.40–$173.00	42% below	20%
Short arm cast (elbow to hand) inpatient CPT 29075 29075 Application, cast; elbow to finger (short arm)	$138.40	$173.00	$138.40–$173.00	—	20%
Short arm splint (forearm and hand) CPT 29125 29125 Application of short arm splint (forearm to hand) static	$94.40	$118.00	$94.40–$118.00	36% below	20%
Short arm splint (forearm and hand) CPT 29125 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC TechFee	$149.60	$187.00	$149.60–$187.00	1% above	20%
Short arm splint (forearm and hand) CPT 29125 29125-Short Arm	$149.60	$187.00	$149.60–$187.00	1% above	20%
Short arm splint (forearm and hand) inpatient CPT 29125 29125 Application of short arm splint (forearm to hand) static	$94.40	$118.00	$94.40–$118.00	—	20%
Short arm splint (forearm and hand) inpatient CPT 29125 29125-Short Arm	$149.60	$187.00	$149.60–$187.00	—	20%
Short arm splint (forearm and hand) inpatient CPT 29125 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC TechFee	$149.60	$187.00	$149.60–$187.00	—	20%
Short leg cast (below the knee) CPT 29405 29405 Application of short leg cast (below knee to toes)	$160.00	$200.00	$160.00–$200.00	43% below	20%
Short leg cast (below the knee) inpatient CPT 29405 29405 Application of short leg cast (below knee to toes)	$160.00	$200.00	$160.00–$200.00	—	20%
Short leg splint (calf to foot) CPT 29515 29515 Application of short leg splint (calf to foot)	$77.60	$97.00	$77.60–$97.00	53% below	20%
Short leg splint (calf to foot) CPT 29515 29515-Short Leg	$149.60	$187.00	$149.60–$187.00	9% below	20%
Short leg splint (calf to foot) CPT 29515 29515 APPLICATION SHORT LEG SPLINT CALF FOOT TechFee	$149.60	$187.00	$149.60–$187.00	9% below	20%
Short leg splint (calf to foot) CPT 29515 29515 Application of short leg splint (calf to foot).	$431.20	$539.00	$431.20–$539.00	161% above	20%
Short leg splint (calf to foot) inpatient CPT 29515 29515 Application of short leg splint (calf to foot)	$77.60	$97.00	$77.60–$97.00	—	20%
Short leg splint (calf to foot) inpatient CPT 29515 29515 APPLICATION SHORT LEG SPLINT CALF FOOT TechFee	$149.60	$187.00	$149.60–$187.00	—	20%
Short leg splint (calf to foot) inpatient CPT 29515 29515-Short Leg	$149.60	$187.00	$149.60–$187.00	—	20%
Short leg splint (calf to foot) inpatient CPT 29515 29515 Application of short leg splint (calf to foot).	$431.20	$539.00	$431.20–$539.00	—	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 29824 Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface	$784.00	$980.00	$784.00–$980.00	93% below	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 29824 SHOULDER ARTHROSCOPY, DISTAL CLAVICULECT	$5,159.20	$6,449.00	$5,159.20–$6,449.00	51% below	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 29824 Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface	$784.00	$980.00	$784.00–$980.00	—	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 29824 SHOULDER ARTHROSCOPY, DISTAL CLAVICULECT	$5,159.20	$6,449.00	$5,159.20–$6,449.00	—	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 29826 SHOULDER ARTHROSCOPY DECOMPRESSION	$429.60	$537.00	$429.60–$537.00	97% below	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 29826 Arthroscopy, shoulder, surgical; decompress subacromial space w/ part acromioplasty w/ release	$1,025.60	$1,282.00	$1,025.60–$1,282.00	92% below	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 29826 SHOULDER ARTHROSCOPY DECOMPRESSION	$429.60	$537.00	$429.60–$537.00	—	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 29826 Arthroscopy, shoulder, surgical; decompress subacromial space w/ part acromioplasty w/ release	$1,025.60	$1,282.00	$1,025.60–$1,282.00	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; <2.5cm	$112.80	$141.00	$112.80–$141.00	49% below	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< TechFee	$208.00	$260.00	$208.00–$260.00	6% below	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001-Scalp/Neck/Trunk/Genital/Extremity <= 2.5 cm	$208.00	$260.00	$208.00–$260.00	6% below	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 12001 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; <2.5cm	$112.80	$141.00	$112.80–$141.00	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 12001-Scalp/Neck/Trunk/Genital/Extremity <= 2.5 cm	$208.00	$260.00	$208.00–$260.00	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< TechFee	$208.00	$260.00	$208.00–$260.00	—	20%
Skin biopsy, punch, one lesion CPT 11104 11104 Punch biopsy of skin (including simple closure, when performed); single lesion	$112.00	$140.00	$112.00–$140.00	57% below	20%
Skin biopsy, punch, one lesion CPT 11104 11104 Punch biopsy of skin (including simple closure, when performed); single lesion PIKE	$840.00	$1,050.00	$840.00–$1,050.00	221% above	20%
Skin biopsy, punch, one lesion inpatient CPT 11104 11104 Punch biopsy of skin (including simple closure, when performed); single lesion	$112.00	$140.00	$112.00–$140.00	—	20%
Skin biopsy, punch, one lesion inpatient CPT 11104 11104 Punch biopsy of skin (including simple closure, when performed); single lesion PIKE	$840.00	$1,050.00	$840.00–$1,050.00	—	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 11600 Excision, malignant lesion including margins, trunk, arms, or legs; < 0.5cm	$300.80	$376.00	$300.80–$376.00	13% below	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 11600 Excision Malignant Lesion (trunk, arms, or legs), </=0.5CM	$668.80	$836.00	$668.80–$836.00	94% above	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 11600 Excision, malignant lesion including margins, trunk, arms, or legs; < 0.5cm	$300.80	$376.00	$300.80–$376.00	—	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 11600 Excision Malignant Lesion (trunk, arms, or legs), </=0.5CM	$668.80	$836.00	$668.80–$836.00	—	20%
Skin tag removal, up to 15 tags CPT 11200 11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions	$104.00	$130.00	$104.00–$130.00	29% below	20%
Skin tag removal, up to 15 tags CPT 11200 11200 REMOVAL SKIN TAGS 1-15	$668.80	$836.00	$668.80–$836.00	354% above	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions	$104.00	$130.00	$104.00–$130.00	—	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 11200 REMOVAL SKIN TAGS 1-15	$668.80	$836.00	$668.80–$836.00	—	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC ProFee	$232.80	$291.00	$232.80–$291.00	54% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270-Lumbar Puncture Diagnostic	$256.00	$320.00	$256.00–$320.00	49% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 Spinal puncture, lumbar, diagnostic	$1,200.00	$1,500.00	$1,200.00–$1,500.00	138% above	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 62270 SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC ProFee	$232.80	$291.00	$232.80–$291.00	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 62270-Lumbar Puncture Diagnostic	$256.00	$320.00	$256.00–$320.00	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 62270 Spinal puncture, lumbar, diagnostic	$1,200.00	$1,500.00	$1,200.00–$1,500.00	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; 2.6-7.5cm	$132.00	$165.00	$132.00–$165.00	54% below	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM TechFee	$208.00	$260.00	$208.00–$260.00	28% below	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002-Scalp/Neck/Trunk/Genital/Extremity 2.6-7.5 cm	$208.00	$260.00	$208.00–$260.00	28% below	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 12002 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; 2.6-7.5cm	$132.00	$165.00	$132.00–$165.00	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM TechFee	$208.00	$260.00	$208.00–$260.00	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 12002-Scalp/Neck/Trunk/Genital/Extremity 2.6-7.5 cm	$208.00	$260.00	$208.00–$260.00	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< TechFee	$208.00	$260.00	$208.00–$260.00	22% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011-Face/Ear/Eyelid/Nose/Lip Less Than/Equal to 2.5 cm	$208.00	$260.00	$208.00–$260.00	22% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 Simple repair of wounds of face, ears, eyelids, nose, lips, mucous membra; <2.5cm	$228.80	$286.00	$228.80–$286.00	14% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 12011-Face/Ear/Eyelid/Nose/Lip Less Than/Equal to 2.5 cm	$208.00	$260.00	$208.00–$260.00	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< TechFee	$208.00	$260.00	$208.00–$260.00	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 12011 Simple repair of wounds of face, ears, eyelids, nose, lips, mucous membra; <2.5cm	$228.80	$286.00	$228.80–$286.00	—	20%
TURP (transurethral resection of the prostate) CPT 52601 52601 PROSTATECTOMY (TURP)	$11,876.00	$14,845.00	$11,876.00–$14,845.00	20% above	20%
TURP (transurethral resection of the prostate) CPT 52601 52601 Transurethral electrosurgical resection of prostate, incld control of postoperative bleeding	$12,636.00	$15,795.00	$12,636.00–$15,795.00	27% above	20%
TURP (transurethral resection of the prostate) inpatient CPT 52601 52601 PROSTATECTOMY (TURP)	$11,876.00	$14,845.00	$11,876.00–$14,845.00	—	20%
TURP (transurethral resection of the prostate) inpatient CPT 52601 52601 Transurethral electrosurgical resection of prostate, incld control of postoperative bleeding	$12,636.00	$15,795.00	$12,636.00–$15,795.00	—	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion	$120.00	$150.00	$120.00–$150.00	37% below	20%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion	$120.00	$150.00	$120.00–$150.00	—	20%
Thoracentesis with imaging guidance CPT 32555 32555-Thoracentesis w/ Imaging Guidance	$259.20	$324.00	$259.20–$324.00	71% below	20%
Thoracentesis with imaging guidance CPT 32555 32555 THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING TechFee	$259.20	$324.00	$259.20–$324.00	71% below	20%
Thoracentesis with imaging guidance CPT 32555 4132421A OPS THORACENTESIS	$443.20	$554.00	$443.20–$554.00	51% below	20%
Thoracentesis with imaging guidance CPT 32555 32555 THORACENTESIS	$443.20	$554.00	$443.20–$554.00	51% below	20%
Thoracentesis with imaging guidance CPT 32555 US Thoracentesis	$1,543.20	$1,929.00	$1,543.20–$1,929.00	72% above	20%
Thoracentesis with imaging guidance inpatient CPT 32555 32555 THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING TechFee	$259.20	$324.00	$259.20–$324.00	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 32555-Thoracentesis w/ Imaging Guidance	$259.20	$324.00	$259.20–$324.00	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 4132421A OPS THORACENTESIS	$443.20	$554.00	$443.20–$554.00	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 32555 THORACENTESIS	$443.20	$554.00	$443.20–$554.00	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 US Thoracentesis	$1,543.20	$1,929.00	$1,543.20–$1,929.00	—	20%
Tonsil and adenoid removal, age 12 or older CPT 42821 42821 TONSILLECTOMY AND ADENOIDECTOMY; AGE 12 OR OVER ProFee	$420.00	$525.00	$420.00–$525.00	90% below	20%
Tonsil and adenoid removal, age 12 or older CPT 42821 42821 Tonsillectomy and adenoidectomy; age 12 or over	$7,452.80	$9,316.00	$7,452.80–$9,316.00	83% above	20%
Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 42821 TONSILLECTOMY AND ADENOIDECTOMY; AGE 12 OR OVER ProFee	$420.00	$525.00	$420.00–$525.00	—	20%
Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 42821 Tonsillectomy and adenoidectomy; age 12 or over	$7,452.80	$9,316.00	$7,452.80–$9,316.00	—	20%
Tonsil and adenoid removal, child under 12 CPT 42820 42820 TONSILLECTOMY AND ADENOIDECTOMY; YOUNGER THAN AGE 12 ProFee	$358.40	$448.00	$358.40–$448.00	91% below	20%
Tonsil and adenoid removal, child under 12 CPT 42820 42820 TONSILLECTOMY AND ADENOIDECTOMY YOUNGER THAN AGE 12	$10,120.00	$12,650.00	$10,120.00–$12,650.00	168% above	20%
Tonsil and adenoid removal, child under 12 inpatient CPT 42820 42820 TONSILLECTOMY AND ADENOIDECTOMY; YOUNGER THAN AGE 12 ProFee	$358.40	$448.00	$358.40–$448.00	—	20%
Tonsil and adenoid removal, child under 12 inpatient CPT 42820 42820 TONSILLECTOMY AND ADENOIDECTOMY YOUNGER THAN AGE 12	$10,120.00	$12,650.00	$10,120.00–$12,650.00	—	20%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 42826 TONSILLECTOMY, PRIMARY OR SECONDARY; AGE 12 OR OVER ProFee	$364.00	$455.00	$364.00–$455.00	89% below	20%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 42826 Tonsillectomy, primary or secondary; age 12 or over	$7,356.00	$9,195.00	$7,356.00–$9,195.00	126% above	20%
Tonsil removal (tonsillectomy) only, age 12 or older inpatient CPT 42826 42826 TONSILLECTOMY, PRIMARY OR SECONDARY; AGE 12 OR OVER ProFee	$364.00	$455.00	$364.00–$455.00	—	20%
Tonsil removal (tonsillectomy) only, age 12 or older inpatient CPT 42826 42826 Tonsillectomy, primary or secondary; age 12 or over	$7,356.00	$9,195.00	$7,356.00–$9,195.00	—	20%
Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 42825 Tonsillectomy, primary or secondary; younger than age 12	$7,614.40	$9,518.00	$7,614.40–$9,518.00	70% above	20%
Tonsil removal (tonsillectomy) only, child under 12 inpatient CPT 42825 42825 Tonsillectomy, primary or secondary; younger than age 12	$7,614.40	$9,518.00	$7,614.40–$9,518.00	—	20%
Total hip replacement CPT 27130 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement	$2,267.20	$2,834.00	$2,267.20–$2,834.00	23% below	20%
Total hip replacement inpatient CPT 27130 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement	$2,267.20	$2,834.00	$2,267.20–$2,834.00	—	20%
Total knee replacement CPT 27447 27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments	$2,422.40	$3,028.00	$2,422.40–$3,028.00	22% below	20%
Total knee replacement CPT 27447 27447 ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHOUT PATEL	$21,600.00	$27,000.00	$21,600.00–$27,000.00	599% above	20%
Total knee replacement inpatient CPT 27447 27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments	$2,422.40	$3,028.00	$2,422.40–$3,028.00	—	20%
Total knee replacement inpatient CPT 27447 27447 ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHOUT PATEL	$21,600.00	$27,000.00	$21,600.00–$27,000.00	—	20%
Total shoulder replacement CPT 23472 23472 Arthroplasty, glenohumeral joint; total shoulder	$1,956.00	$2,445.00	$1,956.00–$2,445.00	85% below	20%
Total shoulder replacement inpatient CPT 23472 23472 Arthroplasty, glenohumeral joint; total shoulder	$1,956.00	$2,445.00	$1,956.00–$2,445.00	—	20%
Trigger finger release surgery CPT 26055 26055 Tendon sheath incision (eg, for trigger finger)	$316.00	$395.00	$316.00–$395.00	80% below	20%
Trigger finger release surgery CPT 26055 26055 TRIGGER FINGER RELEASE	$1,438.40	$1,798.00	$1,438.40–$1,798.00	9% below	20%
Trigger finger release surgery inpatient CPT 26055 26055 Tendon sheath incision (eg, for trigger finger)	$316.00	$395.00	$316.00–$395.00	—	20%
Trigger finger release surgery inpatient CPT 26055 26055 TRIGGER FINGER RELEASE	$1,438.40	$1,798.00	$1,438.40–$1,798.00	—	20%
Trigger point injections, 1 or 2 muscles CPT 20552 20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)	$56.00	$70.00	$56.00–$70.00	73% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 20552 TRIGGER POINT INJECTION	$280.80	$351.00	$280.80–$351.00	37% above	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)	$56.00	$70.00	$56.00–$70.00	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552 TRIGGER POINT INJECTION	$280.80	$351.00	$280.80–$351.00	—	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy w/ Clip Right	$2,000.00	$2,500.00	$2,000.00–$2,500.00	12% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy Right	$2,000.00	$2,500.00	$2,000.00–$2,500.00	12% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy Left	$2,000.00	$2,500.00	$2,000.00–$2,500.00	12% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy w/ Clip Left	$2,000.00	$2,500.00	$2,000.00–$2,500.00	12% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy w/ Clip Right	$2,000.00	$2,500.00	$2,000.00–$2,500.00	—	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy Left	$2,000.00	$2,500.00	$2,000.00–$2,500.00	—	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy Right	$2,000.00	$2,500.00	$2,000.00–$2,500.00	—	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy w/ Clip Left	$2,000.00	$2,500.00	$2,000.00–$2,500.00	—	20%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 43249 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DILATION ProFee	$296.80	$371.00	$296.80–$371.00	88% below	20%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 43249 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DILATION ProFee	$296.80	$371.00	$296.80–$371.00	—	20%
Upper endoscopy (EGD) with biopsy CPT 43239 43239 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE ProFee	$312.80	$391.00	$312.80–$391.00	82% below	20%
Upper endoscopy (EGD) with biopsy CPT 43239 43239 EGD W/BIOPSY	$813.60	$1,017.00	$813.60–$1,017.00	52% below	20%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 43239 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE ProFee	$312.80	$391.00	$312.80–$391.00	—	20%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 43239 EGD W/BIOPSY	$813.60	$1,017.00	$813.60–$1,017.00	—	20%
Upper endoscopy (EGD) with injection into the lining CPT 43236 43236 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED SUBMUCOSAL INJECTION(S) ProFee	$676.80	$846.00	$676.80–$846.00	67% below	20%
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 43236 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED SUBMUCOSAL INJECTION(S) ProFee	$676.80	$846.00	$676.80–$846.00	—	20%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 43251 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP(S), O ProFee	$620.00	$775.00	$620.00–$775.00	69% below	20%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 43251 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP(S), O ProFee	$620.00	$775.00	$620.00–$775.00	—	20%
Upper endoscopy (EGD), diagnostic CPT 43235 43235 ESOPHAGOGASTRODUODENOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC INCLUDING COLLECTION OF S ProFee	$278.40	$348.00	$278.40–$348.00	74% below	20%
Upper endoscopy (EGD), diagnostic CPT 43235 43235 GASTROSCOPY INTO DUODENUM	$815.20	$1,019.00	$815.20–$1,019.00	25% below	20%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 43235 ESOPHAGOGASTRODUODENOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC INCLUDING COLLECTION OF S ProFee	$278.40	$348.00	$278.40–$348.00	—	20%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 43235 GASTROSCOPY INTO DUODENUM	$815.20	$1,019.00	$815.20–$1,019.00	—	20%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 55250 Vasectomy, unilateral or bilateral, including postoperative semen examination(s)	$509.60	$637.00	$509.60–$637.00	—	20%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 55250 VASECTOMY UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN EXAMINAT	$3,600.00	$4,500.00	$3,600.00–$4,500.00	—	20%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 55250 Vasectomy, unilateral or bilateral, including postoperative semen examination(s)	$509.60	$637.00	$509.60–$637.00	—	20%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 55250 VASECTOMY UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN EXAMINAT	$3,600.00	$4,500.00	$3,600.00–$4,500.00	—	20%
Wart removal, up to 14 warts CPT 17110 17110 Destruction of benign lesions 1-14 lesions	$120.00	$150.00	$120.00–$150.00	24% below	20%
Wart removal, up to 14 warts inpatient CPT 17110 17110 Destruction of benign lesions 1-14 lesions	$120.00	$150.00	$120.00–$150.00	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Debridement, subcutaneous tissue; first 20 sq cm or less	$89.60	$112.00	$89.60–$112.00	77% below	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 DEBRIDE SKIN SBQ TISSUE <=20 SQ CM CHARGE	$903.20	$1,129.00	$903.20–$1,129.00	135% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 11042 Debridement, subcutaneous tissue; first 20 sq cm or less	$89.60	$112.00	$89.60–$112.00	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 11042 DEBRIDE SKIN SBQ TISSUE <=20 SQ CM CHARGE	$903.20	$1,129.00	$903.20–$1,129.00	—	20%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 25607 Open tx distal radial extra-articular fx or epiphyseal separation, with internal fixation	$736.80	$921.00	$736.80–$921.00	85% below	20%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 25607 Open tx distal radial extra-articular fx or epiphyseal separation, with internal fixation	$736.80	$921.00	$736.80–$921.00	—	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSE Fresh Frozen Plasma	$520.00	$650.00	$520.00–$650.00	21% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Transfuse Platelet Product Bill Only	$520.00	$650.00	$520.00–$650.00	21% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Transfuse Platelet Product	$520.00	$650.00	$520.00–$650.00	21% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 36430 BLOOD ADM	$520.00	$650.00	$520.00–$650.00	21% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 36430 Blood Product Administration	$520.00	$650.00	$520.00–$650.00	21% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Transfuse Red Blood Cells Leukoreduced	$520.00	$650.00	$520.00–$650.00	21% below	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 BLOOD ADM	$520.00	$650.00	$520.00–$650.00	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfuse Platelet Product	$520.00	$650.00	$520.00–$650.00	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfuse Platelet Product Bill Only	$520.00	$650.00	$520.00–$650.00	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSE Fresh Frozen Plasma	$520.00	$650.00	$520.00–$650.00	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 Blood Product Administration	$520.00	$650.00	$520.00–$650.00	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfuse Red Blood Cells Leukoreduced	$520.00	$650.00	$520.00–$650.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction	$30.40	$38.00	$30.40–$38.00	81% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Mini-Neb Subsequent CHARGE	$71.20	$89.00	$71.20–$89.00	55% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Meter Dose Inhaler Subsequent CHARGE	$71.20	$89.00	$71.20–$89.00	55% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment	$80.00	$100.00	$80.00–$100.00	49% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Meter Dose Inhaler Treatment	$80.00	$100.00	$80.00–$100.00	49% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Aerosol Initial CHARGE	$82.40	$103.00	$82.40–$103.00	48% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Mini-Neb Initial CHARGE	$101.60	$127.00	$101.60–$127.00	36% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Meter Dose Inhaler Initial CHARGE	$101.60	$127.00	$101.60–$127.00	36% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction	$30.40	$38.00	$30.40–$38.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Meter Dose Inhaler Subsequent CHARGE	$71.20	$89.00	$71.20–$89.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Mini-Neb Subsequent CHARGE	$71.20	$89.00	$71.20–$89.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Meter Dose Inhaler Treatment	$80.00	$100.00	$80.00–$100.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Treatment	$80.00	$100.00	$80.00–$100.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Aerosol Initial CHARGE	$82.40	$103.00	$82.40–$103.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Meter Dose Inhaler Initial CHARGE	$101.60	$127.00	$101.60–$127.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Mini-Neb Initial CHARGE	$101.60	$127.00	$101.60–$127.00	—	20%
Chemotherapy IV infusion, first hour CPT 96413 96413 IV Infusion Initial Chemotherapy, 16 mins to 1 hour	$434.40	$543.00	$434.40–$543.00	at median	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 96413 IV Infusion Initial Chemotherapy, 16 mins to 1 hour	$434.40	$543.00	$434.40–$543.00	—	20%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 92557 Comprehensive audiometry threshold evaluation and speech recognition	$64.00	$80.00	$64.00–$80.00	63% below	20%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 92557 Comprehensive audiometry threshold evaluation and speech recognition	$64.00	$80.00	$64.00–$80.00	—	20%
Critical care, first 30 to 74 minutes CPT 99291 99291 Facility Level Critical Care Ill/Injured Patient Init 30 to 74 Min	$705.60	$882.00	$705.60–$882.00	48% below	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 99291 Facility Level Critical Care Ill/Injured Patient Init 30 to 74 Min	$705.60	$882.00	$705.60–$882.00	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Misc. procedure – see order details	$40.00	$50.00	$40.00–$50.00	79% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 93005 EKG w/ 12+ leads; Tracing Only	$148.00	$185.00	$148.00–$185.00	22% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 CV ECG Acquisition	$148.00	$185.00	$148.00–$185.00	22% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 CV Electrocardiogram 12 Lead	$148.00	$185.00	$148.00–$185.00	22% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG POC	$148.00	$185.00	$148.00–$185.00	22% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 93000 Electrocardiogram 12 Lead	$164.00	$205.00	$164.00–$205.00	14% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Misc. procedure – see order details	$40.00	$50.00	$40.00–$50.00	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 CV ECG Acquisition	$148.00	$185.00	$148.00–$185.00	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 93005 EKG w/ 12+ leads; Tracing Only	$148.00	$185.00	$148.00–$185.00	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 CV Electrocardiogram 12 Lead	$148.00	$185.00	$148.00–$185.00	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG POC	$148.00	$185.00	$148.00–$185.00	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 93000 Electrocardiogram 12 Lead	$164.00	$205.00	$164.00–$205.00	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 ED VISIT FOR E&M PATIENT, LEV 1, MAY NOT REQ PRESENCE OF PHYSICIAN OR OTHER, CC	$140.00	$175.00	$140.00–$175.00	at median	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 99281 ED VISIT FOR E&M PATIENT, LEV 1, MAY NOT REQ PRESENCE OF PHYSICIAN OR OTHER, CC	$140.00	$175.00	$140.00–$175.00	—	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 ED VISIT E&M PATIENT, LEV 2, REQ MED APPROP HSTRY/EXAM/MDM, CC	$240.00	$300.00	$240.00–$300.00	1% above	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 99282 ED VISIT E&M PATIENT, LEV 2, REQ MED APPROP HSTRY/EXAM/MDM, CC	$240.00	$300.00	$240.00–$300.00	—	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 ED VISIT E&M PATIENT, LEV 3, REQ MED APPROP HSTRY/EXAM/LOW MDM, CC	$360.00	$450.00	$360.00–$450.00	18% below	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 99283 ED VISIT E&M PATIENT, LEV 3, REQ MED APPROP HSTRY/EXAM/LOW MDM, CC	$360.00	$450.00	$360.00–$450.00	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 ED VISIT E&M PATIENT, LEV 4, REQ MED APPROP HSTRY/EXAM/MODERATE MDM, CC	$520.00	$650.00	$520.00–$650.00	23% below	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 99284 ED VISIT E&M PATIENT, LEV 4, REQ MED APPROP HSTRY/EXAM/MODERATE MDM, CC	$520.00	$650.00	$520.00–$650.00	—	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 ED VISIT E M PATIENT, LEV 5, REQ MED APPROP HSTRY/EXAM/HIGH MDM, CC	$680.00	$850.00	$680.00–$850.00	36% below	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 99285 ED VISIT E M PATIENT, LEV 5, REQ MED APPROP HSTRY/EXAM/HIGH MDM, CC	$680.00	$850.00	$680.00–$850.00	—	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 Walking Stress Test	$583.20	$729.00	$583.20–$729.00	29% below	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 Stress Test	$583.20	$729.00	$583.20–$729.00	29% below	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 EKG-LEXISCAN STRESS TEST	$583.20	$729.00	$583.20–$729.00	29% below	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 EKG-DOBUTAMINE	$583.20	$729.00	$583.20–$729.00	29% below	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Stress Test	$583.20	$729.00	$583.20–$729.00	—	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 EKG-DOBUTAMINE	$583.20	$729.00	$583.20–$729.00	—	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 EKG-LEXISCAN STRESS TEST	$583.20	$729.00	$583.20–$729.00	—	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Walking Stress Test	$583.20	$729.00	$583.20–$729.00	—	20%
Family therapy with the patient, 50 minutes CPT 90847 90847 Family psychotherapy, conjoint psychotherapy, with patient present	$128.00	$160.00	$128.00–$160.00	25% below	20%
Family therapy with the patient, 50 minutes inpatient CPT 90847 90847 Family psychotherapy, conjoint psychotherapy, with patient present	$128.00	$160.00	$128.00–$160.00	—	20%
Family therapy without the patient, 50 minutes CPT 90846 90846 Family psychotherapy without the patient present	$112.00	$140.00	$112.00–$140.00	52% below	20%
Family therapy without the patient, 50 minutes inpatient CPT 90846 90846 Family psychotherapy without the patient present	$112.00	$140.00	$112.00–$140.00	—	20%
Group psychotherapy session CPT 90853 90853 Group psychotherapy (other than of a multiple-family group)	$42.40	$53.00	$42.40–$53.00	80% below	20%
Group psychotherapy session inpatient CPT 90853 90853 Group psychotherapy (other than of a multiple-family group)	$42.40	$53.00	$42.40–$53.00	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 OPS IV FLUIDS INITIAL	$177.60	$222.00	$177.60–$222.00	28% below	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 1396360A IVF INIT'L CHARGE	$177.60	$222.00	$177.60–$222.00	28% below	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 - ED Hydration, first hour	$182.60	$228.25	$182.60–$228.25	26% below	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 OPS IV FLUIDS INITIAL	$177.60	$222.00	$177.60–$222.00	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 1396360A IVF INIT'L CHARGE	$177.60	$222.00	$177.60–$222.00	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 - ED Hydration, first hour	$182.60	$228.25	$182.60–$228.25	—	20%
IV infusion of a medicine, first hour CPT 96365 96365 IV THERAPEUTIC INITIAL CHARGE	$188.80	$236.00	$188.80–$236.00	38% below	20%
IV infusion of a medicine, first hour CPT 96365 96365 OPSIV Therapeutic Infusion 16 min-1 hour	$204.00	$255.00	$204.00–$255.00	33% below	20%
IV infusion of a medicine, first hour CPT 96365 96365- ED IV tx, first hour	$204.00	$255.00	$204.00–$255.00	33% below	20%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 IV THERAPEUTIC INITIAL CHARGE	$188.80	$236.00	$188.80–$236.00	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 96365- ED IV tx, first hour	$204.00	$255.00	$204.00–$255.00	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 OPSIV Therapeutic Infusion 16 min-1 hour	$204.00	$255.00	$204.00–$255.00	—	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 INJ IM/SUB THERAPUTIC/DIAGNOS ProFee	$24.00	$30.00	$24.00–$30.00	75% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular:	$24.00	$30.00	$24.00–$30.00	75% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 ED Subq/IM Injection	$96.80	$121.00	$96.80–$121.00	at median	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 IM OR SUBCUT INJ CHARGE	$96.80	$121.00	$96.80–$121.00	at median	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 OPS IM or SQ Injection	$96.80	$121.00	$96.80–$121.00	at median	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 INJ IM/SUB THERAPUTIC/DIAGNOS ProFee	$24.00	$30.00	$24.00–$30.00	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular:	$24.00	$30.00	$24.00–$30.00	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 ED Subq/IM Injection	$96.80	$121.00	$96.80–$121.00	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 IM OR SUBCUT INJ CHARGE	$96.80	$121.00	$96.80–$121.00	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 OPS IM or SQ Injection	$96.80	$121.00	$96.80–$121.00	—	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 90791 Psychiatric diagnostic evaluation	$264.00	$330.00	$264.00–$330.00	18% above	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 90791 Psychiatric diagnostic evaluation	$264.00	$330.00	$264.00–$330.00	—	20%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 95910 - NCS: 7-8 STUDIES ProFee	$158.40	$198.00	$158.40–$198.00	66% below	20%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 95910 Nerve conduction studies; 7-8 studies	$1,728.00	$2,160.00	$1,728.00–$2,160.00	273% above	20%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 95910 NERVE CONDUCTION STUDY 7-8 STUDIES	$1,728.00	$2,160.00	$1,728.00–$2,160.00	273% above	20%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 95910 - NCS: 7-8 STUDIES ProFee	$158.40	$198.00	$158.40–$198.00	—	20%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 95910 Nerve conduction studies; 7-8 studies	$1,728.00	$2,160.00	$1,728.00–$2,160.00	—	20%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 95910 NERVE CONDUCTION STUDY 7-8 STUDIES	$1,728.00	$2,160.00	$1,728.00–$2,160.00	—	20%
Neuromuscular re-education, 15 minutes CPT 97112 97112 OT NEUROMUSCULAR RE-ED CHARGE	$85.60	$107.00	$85.60–$107.00	4% below	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 97112 OT NEUROMUSCULAR RE-ED CHARGE	$85.60	$107.00	$85.60–$107.00	—	20%
New patient office visit, about 30 minutes CPT 99203 99203 Office/Outpatient Visit - New Patient, Level 3 (30-44 min)	$120.00	$150.00	$120.00–$150.00	11% below	20%
New patient office visit, about 30 minutes CPT 99203 99203 PRO LEVEL 3 VISIT NEW PT ProFee	$156.00	$195.00	$156.00–$195.00	15% above	20%
New patient office visit, about 30 minutes CPT 99203 99203 - Provider Outpatient Visit, NEW PT Level 3, 30 min-PIKE	$156.00	$195.00	$156.00–$195.00	15% above	20%
New patient office visit, about 30 minutes CPT 99203 99203 NEW PATIENT VISIT 3 CHARGE	$400.00	$500.00	$400.00–$500.00	196% above	20%
New patient office visit, about 30 minutes inpatient CPT 99203 99203 Office/Outpatient Visit - New Patient, Level 3 (30-44 min)	$120.00	$150.00	$120.00–$150.00	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 99203 PRO LEVEL 3 VISIT NEW PT ProFee	$156.00	$195.00	$156.00–$195.00	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 99203 - Provider Outpatient Visit, NEW PT Level 3, 30 min-PIKE	$156.00	$195.00	$156.00–$195.00	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 99203 NEW PATIENT VISIT 3 CHARGE	$400.00	$500.00	$400.00–$500.00	—	20%
New patient office visit, about 45 minutes CPT 99204 99204 Office/Outpatient Visit - New Patient, Level 4 (45-59 min)	$148.00	$185.00	$148.00–$185.00	18% below	20%
New patient office visit, about 45 minutes CPT 99204 99204 PRO LEVEL 4 VISIT NEW PT ProFee	$184.00	$230.00	$184.00–$230.00	2% above	20%
New patient office visit, about 45 minutes CPT 99204 99204 - Provider Outpatient Visit, NEW PT Level 4, 45 min-PIKE	$184.00	$230.00	$184.00–$230.00	2% above	20%
New patient office visit, about 45 minutes CPT 99204 99204 NEW PATIENT VISIT 4 CHARGE	$520.00	$650.00	$520.00–$650.00	187% above	20%
New patient office visit, about 45 minutes inpatient CPT 99204 99204 Office/Outpatient Visit - New Patient, Level 4 (45-59 min)	$148.00	$185.00	$148.00–$185.00	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 99204 - Provider Outpatient Visit, NEW PT Level 4, 45 min-PIKE	$184.00	$230.00	$184.00–$230.00	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 99204 PRO LEVEL 4 VISIT NEW PT ProFee	$184.00	$230.00	$184.00–$230.00	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 99204 NEW PATIENT VISIT 4 CHARGE	$520.00	$650.00	$520.00–$650.00	—	20%
New patient office visit, about 60 minutes CPT 99205 FRC NEW PT DAVISON CHARGE	$87.20	$109.00	$87.20–$109.00	66% below	20%
New patient office visit, about 60 minutes CPT 99205 FRC NEW PT ELLISON CHARGE	$87.20	$109.00	$87.20–$109.00	66% below	20%
New patient office visit, about 60 minutes CPT 99205 FRC NEW PT VENKAT CHARGE	$87.20	$109.00	$87.20–$109.00	66% below	20%
New patient office visit, about 60 minutes CPT 99205 FRC NEW PT COLBERT CHARGE	$87.20	$109.00	$87.20–$109.00	66% below	20%
New patient office visit, about 60 minutes CPT 99205 Cardiopulmonary New Patient Visit	$93.60	$117.00	$93.60–$117.00	64% below	20%
New patient office visit, about 60 minutes CPT 99205 99205 Office/Outpatient Visit - New Patient, Level 5 (60 Min)	$208.00	$260.00	$208.00–$260.00	20% below	20%
New patient office visit, about 60 minutes CPT 99205 99205 LHI Disability	$208.00	$260.00	$208.00–$260.00	20% below	20%
New patient office visit, about 60 minutes CPT 99205 99205 Nurse Office/Outpatient Visit - New Patient, Level 5 (60-74 min)	$240.00	$300.00	$240.00–$300.00	7% below	20%
New patient office visit, about 60 minutes CPT 99205 99205 PRO VST NEW PAT COMPRE/HIGH/COMPL ProFee	$240.00	$300.00	$240.00–$300.00	7% below	20%
New patient office visit, about 60 minutes CPT 99205 99205 - Provider Outpatient Visit, NEW PT Level 5, 60 min-PIKE	$240.00	$300.00	$240.00–$300.00	7% below	20%
New patient office visit, about 60 minutes inpatient CPT 99205 99205 FACILITY ROOM CHARGE NEW PT	$87.20	$109.00	$87.20–$109.00	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 FRC NEW PT ELLISON CHARGE	$87.20	$109.00	$87.20–$109.00	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 FRC NEW PT VENKAT CHARGE	$87.20	$109.00	$87.20–$109.00	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 FRC NEW PT DAVISON CHARGE	$87.20	$109.00	$87.20–$109.00	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 FRC NEW PT COLBERT CHARGE	$87.20	$109.00	$87.20–$109.00	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 Cardiopulmonary New Patient Visit	$93.60	$117.00	$93.60–$117.00	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 99205 Office/Outpatient Visit - New Patient, Level 5 (60 Min)	$208.00	$260.00	$208.00–$260.00	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 99205 LHI Disability	$208.00	$260.00	$208.00–$260.00	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 99205 Nurse Office/Outpatient Visit - New Patient, Level 5 (60-74 min)	$240.00	$300.00	$240.00–$300.00	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 99205 - Provider Outpatient Visit, NEW PT Level 5, 60 min-PIKE	$240.00	$300.00	$240.00–$300.00	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 99205 PRO VST NEW PAT COMPRE/HIGH/COMPL ProFee	$240.00	$300.00	$240.00–$300.00	—	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 Office/Outpatient Visit - New Patient, Level 2 (15-29 mins)	$104.00	$130.00	$104.00–$130.00	4% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 - Provider Outpatient Visit, NEW PT Level 2, 15 min-PIKE	$136.00	$170.00	$136.00–$170.00	36% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 NEW PATIENT VISIT 2 CHARGE	$360.00	$450.00	$360.00–$450.00	260% above	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 99202 Office/Outpatient Visit - New Patient, Level 2 (15-29 mins)	$104.00	$130.00	$104.00–$130.00	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 99202 - Provider Outpatient Visit, NEW PT Level 2, 15 min-PIKE	$136.00	$170.00	$136.00–$170.00	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 99202 NEW PATIENT VISIT 2 CHARGE	$360.00	$450.00	$360.00–$450.00	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 97140 MANUAL THERAPY TECHNIQUES PLUS EA 15 MIN ProFee	$33.60	$42.00	$33.60–$42.00	59% below	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 97140 OT MANUAL THERAPY CHARGE	$88.00	$110.00	$88.00–$110.00	8% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 97140 MANUAL THERAPY TECHNIQUES PLUS EA 15 MIN ProFee	$33.60	$42.00	$33.60–$42.00	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 97140 OT MANUAL THERAPY CHARGE	$88.00	$110.00	$88.00–$110.00	—	20%
Preventive checkup, new patient aged 18–39 CPT 99385 99385 Preventive Evaluation, New Pt; 18-39 Yrs	$120.00	$150.00	$120.00–$150.00	14% below	20%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 99385 Preventive Evaluation, New Pt; 18-39 Yrs	$120.00	$150.00	$120.00–$150.00	—	20%
Preventive checkup, new patient aged 40–64 CPT 99386 99386 Preventive Evaluation, New Pt; 40-64 Yrs	$120.00	$150.00	$120.00–$150.00	29% below	20%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 99386 Preventive Evaluation, New Pt; 40-64 Yrs	$120.00	$150.00	$120.00–$150.00	—	20%
Preventive checkup, new patient aged 65 or older CPT 99387 99387 Preventive Evaluation, New Pt; 65+ Yrs	$120.00	$150.00	$120.00–$150.00	27% below	20%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 99387 Preventive Evaluation, New Pt; 65+ Yrs	$120.00	$150.00	$120.00–$150.00	—	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 99395 Preventive Evaluation, Established Pt; 18 to 39 Yrs	$104.00	$130.00	$104.00–$130.00	16% below	20%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 99395 Preventive Evaluation, Established Pt; 18 to 39 Yrs	$104.00	$130.00	$104.00–$130.00	—	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 99396 Preventive Evaluation, Established Pt; 40t to 64 Yrs	$104.00	$130.00	$104.00–$130.00	21% below	20%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 99396 Preventive Evaluation, Established Pt; 40t to 64 Yrs	$104.00	$130.00	$104.00–$130.00	—	20%
Preventive checkup, returning patient aged 65 or older CPT 99397 99397 Preventive Evaluation, Established Pt; 65+ Yrs	$104.00	$130.00	$104.00–$130.00	29% below	20%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 99397 Preventive Evaluation, Established Pt; 65+ Yrs	$104.00	$130.00	$104.00–$130.00	—	20%
Psychiatric evaluation with medical services CPT 90792 90792 Psychiatric diagnostic evaluation with medical services	$158.40	$198.00	$158.40–$198.00	15% below	20%
Psychiatric evaluation with medical services inpatient CPT 90792 90792 Psychiatric diagnostic evaluation with medical services	$158.40	$198.00	$158.40–$198.00	—	20%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 96130 Psychological testing evaluation services by physician or other qualified health care professi	$200.00	$250.00	$200.00–$250.00	6% below	20%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 96130 Psychological testing evaluation services by physician or other qualified health care professi	$200.00	$250.00	$200.00–$250.00	—	20%
Psychotherapy for crisis, first 60 minutes CPT 90839 90839 Psychotherapy for crisis first 60 minutes	$140.00	$175.00	$140.00–$175.00	32% below	20%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 90839 Psychotherapy for crisis first 60 minutes	$140.00	$175.00	$140.00–$175.00	—	20%
Psychotherapy session, 30 minutes CPT 90832 90832 Psychotherapy, 30 minutes with patient and/or family member	$252.00	$315.00	$252.00–$315.00	98% above	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 90832 Psychotherapy, 30 minutes with patient and/or family member	$252.00	$315.00	$252.00–$315.00	—	20%
Psychotherapy session, 45 minutes CPT 90834 90834 Psychotherapy, 45 minutes with patient and/or family member	$264.00	$330.00	$264.00–$330.00	55% above	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 90834 Psychotherapy, 45 minutes with patient and/or family member	$264.00	$330.00	$264.00–$330.00	—	20%
Psychotherapy session, 60 minutes CPT 90837 90837 Psychotherapy, 60 minutes with patient and/or family member	$280.00	$350.00	$280.00–$350.00	25% above	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 90837 Psychotherapy, 60 minutes with patient and/or family member	$280.00	$350.00	$280.00–$350.00	—	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 Office/Outpatient Visit - Established Patient, Level 5 (40-54 min).	$180.00	$225.00	$180.00–$225.00	11% below	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 - Provider Outpatient Visit, EST PT Level 5, 40 min-PIKE	$212.00	$265.00	$212.00–$265.00	5% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 VST EST PAT COMPRE/HIGH/COMPLX ProFee (40-54 mins)	$212.00	$265.00	$212.00–$265.00	5% above	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215 Office/Outpatient Visit - Established Patient, Level 5 (40-54 min).	$180.00	$225.00	$180.00–$225.00	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215 - Provider Outpatient Visit, EST PT Level 5, 40 min-PIKE	$212.00	$265.00	$212.00–$265.00	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215 VST EST PAT COMPRE/HIGH/COMPLX ProFee (40-54 mins)	$212.00	$265.00	$212.00–$265.00	—	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Office/Outpatient Visit - Established Patient, Level 3	$108.00	$135.00	$108.00–$135.00	7% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 - Provider Outpatient Visit, EST PT Level 3, 20 min-PIKE	$136.00	$170.00	$136.00–$170.00	17% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 VST EST PAT EXPANDED/STRGHTFWD ProFee (20-29 mins)	$136.00	$170.00	$136.00–$170.00	17% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 ESTABLISHED PATIENT VISIT 3 CHARGE	$344.00	$430.00	$344.00–$430.00	196% above	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 Office/Outpatient Visit - Established Patient, Level 3	$108.00	$135.00	$108.00–$135.00	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 - Provider Outpatient Visit, EST PT Level 3, 20 min-PIKE	$136.00	$170.00	$136.00–$170.00	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 VST EST PAT EXPANDED/STRGHTFWD ProFee (20-29 mins)	$136.00	$170.00	$136.00–$170.00	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 ESTABLISHED PATIENT VISIT 3 CHARGE	$344.00	$430.00	$344.00–$430.00	—	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Office/Outpatient Visit - Established Patient, Level 4	$132.00	$165.00	$132.00–$165.00	17% below	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 VST EST PAT DET/LOW/MOD/COMPL ProFee (30-39 mins)	$164.00	$205.00	$164.00–$205.00	3% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 - Provider Outpatient Visit, EST PT Level 4, 30 min-PIKE	$164.00	$205.00	$164.00–$205.00	3% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 ESTABLISHED PATIENT VISIT 4 CHARGE	$440.00	$550.00	$440.00–$550.00	176% above	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 Office/Outpatient Visit - Established Patient, Level 4	$132.00	$165.00	$132.00–$165.00	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 VST EST PAT DET/LOW/MOD/COMPL ProFee (30-39 mins)	$164.00	$205.00	$164.00–$205.00	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 - Provider Outpatient Visit, EST PT Level 4, 30 min-PIKE	$164.00	$205.00	$164.00–$205.00	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 ESTABLISHED PATIENT VISIT 4 CHARGE	$440.00	$550.00	$440.00–$550.00	—	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 FRC FOLLOWUP ELLISON CHARGE	$52.00	$65.00	$52.00–$65.00	24% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 FRC FOLLOWUP VENKAT CHARGE	$52.00	$65.00	$52.00–$65.00	24% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 FRC FOLLOWUP DAVISON CHARGE	$52.00	$65.00	$52.00–$65.00	24% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 FRC FOLLOWUP COLBERT CHARGE	$52.00	$65.00	$52.00–$65.00	24% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Cardiopulmonary Follow Up Visit	$56.00	$70.00	$56.00–$70.00	18% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Office/Outpatient Visit - Established Patient, Level 2	$92.00	$115.00	$92.00–$115.00	34% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 - Provider Outpatient Visit, EST PT Level 2, 10 min-PIKE	$120.00	$150.00	$120.00–$150.00	75% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 VST EST PAT FOCUSED/STRGHTFWD ProFee (less than 20 mins)	$120.00	$150.00	$120.00–$150.00	75% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 ESTABLISHED PATIENT VISIT 2 CHARGE	$280.00	$350.00	$280.00–$350.00	308% above	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 FRC FOLLOWUP COLBERT CHARGE	$52.00	$65.00	$52.00–$65.00	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 FRC FOLLOWUP VENKAT CHARGE	$52.00	$65.00	$52.00–$65.00	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 FACILITY ROOM CHRG FOLLOW UP	$52.00	$65.00	$52.00–$65.00	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 FRC FOLLOWUP ELLISON CHARGE	$52.00	$65.00	$52.00–$65.00	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 FRC FOLLOWUP DAVISON CHARGE	$52.00	$65.00	$52.00–$65.00	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Cardiopulmonary Follow Up Visit	$56.00	$70.00	$56.00–$70.00	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 Office/Outpatient Visit - Established Patient, Level 2	$92.00	$115.00	$92.00–$115.00	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 VST EST PAT FOCUSED/STRGHTFWD ProFee (less than 20 mins)	$120.00	$150.00	$120.00–$150.00	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 - Provider Outpatient Visit, EST PT Level 2, 10 min-PIKE	$120.00	$150.00	$120.00–$150.00	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 ESTABLISHED PATIENT VISIT 2 CHARGE	$280.00	$350.00	$280.00–$350.00	—	20%
Specialist consultation, low complexity or 30+ minutes CPT 99243 99243 LEVEL 3 OUTPT CONSULT ProFee	$221.60	$277.00	$221.60–$277.00	24% above	20%
Specialist consultation, low complexity or 30+ minutes CPT 99243 99243 Office Consultation, Level 3	$221.60	$277.00	$221.60–$277.00	24% above	20%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 99243 Office Consultation, Level 3	$221.60	$277.00	$221.60–$277.00	—	20%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 99243 LEVEL 3 OUTPT CONSULT ProFee	$221.60	$277.00	$221.60–$277.00	—	20%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 99244 LEVEL 4 OUTPT CONSULT ProFee	$267.20	$334.00	$267.20–$334.00	9% above	20%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 99244 Office Consultation, Level 4	$267.20	$334.00	$267.20–$334.00	9% above	20%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 99244 LEVEL 4 OUTPT CONSULT ProFee	$267.20	$334.00	$267.20–$334.00	—	20%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 99244 Office Consultation, Level 4	$267.20	$334.00	$267.20–$334.00	—	20%
Speech and language evaluation CPT 92523 92523 EVAL LANGUANGE ONLY CHARGE	$480.00	$600.00	$480.00–$600.00	77% above	20%
Speech and language evaluation CPT 92523 Speech Sound Prod w/ Language Charge	$480.00	$600.00	$480.00–$600.00	77% above	20%
Speech and language evaluation inpatient CPT 92523 Speech Sound Prod w/ Language Charge	$480.00	$600.00	$480.00–$600.00	—	20%
Speech and language evaluation inpatient CPT 92523 92523 EVAL LANGUANGE ONLY CHARGE	$480.00	$600.00	$480.00–$600.00	—	20%
Speech therapy session, individual CPT 92507 92507 ST INDIVIDUAL SPEECH THERAPY CHARGE	$300.80	$376.00	$300.80–$376.00	89% above	20%
Speech therapy session, individual CPT 92507 Tx of Speech/Lang/Voice/Comm/Auditory Chg	$300.80	$376.00	$300.80–$376.00	89% above	20%
Speech therapy session, individual inpatient CPT 92507 92507 ST INDIVIDUAL SPEECH THERAPY CHARGE	$300.80	$376.00	$300.80–$376.00	—	20%
Speech therapy session, individual inpatient CPT 92507 Tx of Speech/Lang/Voice/Comm/Auditory Chg	$300.80	$376.00	$300.80–$376.00	—	20%
Spirometry (breathing test) one side CPT 94010 Flow volume loop - RT CHARGE PFT	$207.20	$259.00	$207.20–$259.00	4% below	20%
Spirometry (breathing test) inpatient one side CPT 94010 Flow volume loop - RT CHARGE PFT	$207.20	$259.00	$207.20–$259.00	—	20%
Spirometry before and after a bronchodilator one side CPT 94060 Spirometry before & after - RT CHARGE PFT	$382.40	$478.00	$382.40–$478.00	15% below	20%
Spirometry before and after a bronchodilator inpatient one side CPT 94060 Spirometry before & after - RT CHARGE PFT	$382.40	$478.00	$382.40–$478.00	—	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 4199195A OPS Phlebotomy	$668.80	$836.00	$668.80–$836.00	256% above	20%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 4199195A OPS Phlebotomy	$668.80	$836.00	$668.80–$836.00	—	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Missouri	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 90653 Influenza vaccine, inactivated (Fluad) High Dose for intramuscular use	$156.00	$195.00	$156.00–$195.00	206% above	20%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 90653 Influenza vaccine, inactivated (Fluad) High Dose for intramuscular use	$156.00	$195.00	$156.00–$195.00	—	20%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 91322 COVID-19 SPIKEVAX VFC 12YR+ 2025-2026	$198.40	$248.00	$198.40–$248.00	7% above	20%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 91322 SARSCOV2 SPIKEVAX 2023-2024 formula 12+yrs	$252.00	$315.00	$252.00–$315.00	36% above	20%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 91322 Moderna Spikevax formula 12+yrs	$288.00	$360.00	$288.00–$360.00	56% above	20%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 91322 COVID-19 SPIKEVAX VFC 12YR+ 2025-2026	$198.40	$248.00	$198.40–$248.00	—	20%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 91322 SARSCOV2 SPIKEVAX 2023-2024 formula 12+yrs	$252.00	$315.00	$252.00–$315.00	—	20%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 91322 Moderna Spikevax formula 12+yrs	$288.00	$360.00	$288.00–$360.00	—	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 91320 Covid-19 Vaccine NON-VFC	$252.00	$315.00	$252.00–$315.00	8% below	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 91320 Covid-19 Vaccine NON-VFC	$252.00	$315.00	$252.00–$315.00	—	20%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 90716 Varicella virus vaccine, live, for subcutaneous use	$124.00	$155.00	$124.00–$155.00	32% below	20%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 90716 Varicella virus vaccine, live, for subcutaneous use	$124.00	$155.00	$124.00–$155.00	—	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 90656 Influenza virus vaccine, trivalent, split virus fluarix	$32.00	$40.00	$32.00–$40.00	46% below	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 90656 Influenza Virus Vaccine Trivalent 0.5ml	$40.00	$50.00	$40.00–$50.00	33% below	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 90656 Influenza virus vaccine, trivalent, split virus fluarix	$32.00	$40.00	$32.00–$40.00	—	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 90656 Influenza Virus Vaccine Trivalent 0.5ml	$40.00	$50.00	$40.00–$50.00	—	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 90651 Vaccine- Gardasil 9 VFC	$368.00	$460.00	$368.00–$460.00	12% above	20%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 90651 Vaccine- Gardasil 9 VFC	$368.00	$460.00	$368.00–$460.00	—	20%
Hepatitis A vaccine, adult dose CPT 90632 90632 Hepatitis A vaccine, adult dosage, for intramuscular use	$76.80	$96.00	$76.80–$96.00	7% below	20%
Hepatitis A vaccine, adult dose inpatient CPT 90632 90632 Hepatitis A vaccine, adult dosage, for intramuscular use	$76.80	$96.00	$76.80–$96.00	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 90746 Vaccine - Hepatitis B Adult Vaccine	$68.00	$85.00	$68.00–$85.00	13% below	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 90746 Vaccine - Hepatitis B Adult Vaccine	$68.00	$85.00	$68.00–$85.00	—	20%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 90662 Influenza virus vaccine High Dose, Inactivated PF Trivalent	$67.20	$84.00	$67.20–$84.00	34% below	20%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 90662 Influenza virus vaccine High Dose, Inactivated PF Trivalent	$67.20	$84.00	$67.20–$84.00	—	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 90707 Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use	$80.00	$100.00	$80.00–$100.00	52% below	20%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 90707 Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use	$80.00	$100.00	$80.00–$100.00	—	20%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 90734 Meningococcal conjugate vaccine, quadrivalent, for intramuscular use	$120.00	$150.00	$120.00–$150.00	7% below	20%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 90734 Meningococcal conjugate vaccine, quadrivalent, for intramuscular use	$120.00	$150.00	$120.00–$150.00	—	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 90677 Pneumococcal 20-valent conjugate vaccine	$280.00	$350.00	$280.00–$350.00	48% below	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 90677 Pneumococcal 20-valent conjugate vaccine	$280.00	$350.00	$280.00–$350.00	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 90732 Pneumococcal polysaccharide vaccine, 23-valent, for subcutaneous or intramuscular use	$104.00	$130.00	$104.00–$130.00	44% below	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 90732 Pneumococcal polysaccharide vaccine, 23-valent, for subcutaneous or intramuscular use	$104.00	$130.00	$104.00–$130.00	—	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 90380 0.5 mL Respiratory syncytial virus, monoclonal antibody, seasonal dose for IM	$532.00	$665.00	$532.00–$665.00	56% below	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 90380 0.5 mL Respiratory syncytial virus, monoclonal antibody, seasonal dose for IM	$532.00	$665.00	$532.00–$665.00	—	20%
Rabies vaccine, one dose CPT 90675 90675 Rabies vaccine, for intramuscular use	$238.40	$298.00	$238.40–$298.00	73% below	20%
Rabies vaccine, one dose inpatient CPT 90675 90675 Rabies vaccine, for intramuscular use	$238.40	$298.00	$238.40–$298.00	—	20%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Shingrix zoster vaccine (Not for MEDICARE PATIENTS)	$240.00	$300.00	$240.00–$300.00	at median	20%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 90750 Zoster (shingles) vaccine (HZV), recombinant, subunit, adjuvanted, for intramuscular use	$544.80	$681.00	$544.80–$681.00	127% above	20%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 Shingrix zoster vaccine (Not for MEDICARE PATIENTS)	$240.00	$300.00	$240.00–$300.00	—	20%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 90750 Zoster (shingles) vaccine (HZV), recombinant, subunit, adjuvanted, for intramuscular use	$544.80	$681.00	$544.80–$681.00	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 90714 Tenivac - Tetanus and diphtheria toxoids (Td), over 18	$28.00	$35.00	$28.00–$35.00	61% below	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 90714 Tenivac - Tetanus and diphtheria toxoids (Td), over 18	$28.00	$35.00	$28.00–$35.00	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 90715 Tdap, when administered to individuals 7 years or older, for intramuscular use	$45.60	$57.00	$45.60–$57.00	55% below	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 90715 Tdap, when administered to individuals 7 years or older, for intramuscular use	$45.60	$57.00	$45.60–$57.00	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 Influenza Immunization administration; first vaccine	$24.00	$30.00	$24.00–$30.00	59% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 Hepatitis B Immunization administration; first vaccine	$24.00	$30.00	$24.00–$30.00	59% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 Pneumococcal Immunization administration; first vaccine	$24.00	$30.00	$24.00–$30.00	59% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 Immunization administration: first vaccine	$24.00	$30.00	$24.00–$30.00	59% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 IM ADM PRQ ID SUBQ IM NJXS 1 VACCINE TechFee	$76.80	$96.00	$76.80–$96.00	30% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471-Vaccine Administration	$76.80	$96.00	$76.80–$96.00	30% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 1990471A INITIAL VACCINE INJ >18YRS CHARGE	$76.80	$96.00	$76.80–$96.00	30% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 INITIAL VACCINE INJ CHARGE	$76.80	$96.00	$76.80–$96.00	30% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 OPS Immunization Administration.	$76.80	$96.00	$76.80–$96.00	30% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 Influenza Immunization administration; first vaccine	$24.00	$30.00	$24.00–$30.00	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 Hepatitis B Immunization administration; first vaccine	$24.00	$30.00	$24.00–$30.00	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 Immunization administration: first vaccine	$24.00	$30.00	$24.00–$30.00	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 Pneumococcal Immunization administration; first vaccine	$24.00	$30.00	$24.00–$30.00	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 IM ADM PRQ ID SUBQ IM NJXS 1 VACCINE TechFee	$76.80	$96.00	$76.80–$96.00	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 1990471A INITIAL VACCINE INJ >18YRS CHARGE	$76.80	$96.00	$76.80–$96.00	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471-Vaccine Administration	$76.80	$96.00	$76.80–$96.00	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 OPS Immunization Administration.	$76.80	$96.00	$76.80–$96.00	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 INITIAL VACCINE INJ CHARGE	$76.80	$96.00	$76.80–$96.00	—	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 Immunization administration; each additional vaccine	$30.40	$38.00	$30.40–$38.00	36% below	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 INJ IMMUNIZATION ADDTL CHARGE	$76.80	$96.00	$76.80–$96.00	62% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472-Vaccine Administration Each Addl	$76.80	$96.00	$76.80–$96.00	62% above	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472 Immunization administration; each additional vaccine	$30.40	$38.00	$30.40–$38.00	—	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472 INJ IMMUNIZATION ADDTL CHARGE	$76.80	$96.00	$76.80–$96.00	—	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472-Vaccine Administration Each Addl	$76.80	$96.00	$76.80–$96.00	—	20%

Source file: https://www.pcmh-mo.org/wp-content/uploads/2026/06/436002764_pike-county-memorial-hospital_standardcharges_0626.csv